IMPACT OF INSTITUTION SIZE, STAFFING PATTERNS, AND INFECTION-CONTROL PRACTICES ON COMMUNICABLE DISEASE OUTBREAKS IN NEW-YORK-STATE NURSING-HOMES

Institutional risk factors associated with the occurrence of nosocomia l respiratory or gastrointestinal disease outbreaks in 1992 were exami ned in a case-cohort study of New York State nursing homes conducted i n 1993. Facility size, staffing patterns, and employee sick leave poli cies were the principal effects found in an unconditional logistic reg ression model. The risk of having respiratory or gastrointestinal dise ase outbreaks was greater in larger nursing homes (adjusted risk ratio (RR) = 1.71 for each 100-bed increase in size, 95% confidence interva l (CI) 1.20-2.42), for nursing homes with a single nursing unit (adjus ted RR = 3.93, 95% CI 0.98-15.71), or those with multiple nursing unit s with shared staff (adjusted RR = 2.51, 95% CI 1.07-5.89), The risk w as less for nursing homes with paid employee sick leave policies (adju sted RR = 0.38, 95% CI 0.15-0.99), Other potential risk factors examin ed in this study, such as the ratio of beds per unit, type of sponsors hip, daily review of laboratory test results, and the proportion of pr ivate beds and patient-to-staff ratio, were not significantly associat ed with the risk of disease outbreaks, The results of this study have direct implications for control of nosocomial disease outbreaks in nur sing homes.