Methods

Qualitative thematic coding was used to review AL regulations (current through 2018) for all 50 states and the District of Columbia. Key search terms included epidemic, pandemic, and infection control. Two graduate student researchers with experience in qualitative coding used an existing data set, curated as part of a larger research study of RC/AL regulation. Coding and analysis were done using ATLAS. ti, version 8.4. 24.0 (ATLAS. ti Scientific Software Development GmbH, Berlin, Germany), and R software, 2019 (R Foundation for Statistical Computing, Vienna, Austria). 5, 6

Results

We identified 31 states describing infection control policies (Table 1). Infection control policies include the routine practice of universal or standard precautions, guidelines for contact with blood or other bodily fluids, or reportable disease guidelines. Some, though not all states, require staff to be trained in infection control. Though the level of detail in the regulation text varies, a total of 32 total states list or describe infection control as a training component (Table 1). Ten states include language surrounding epidemics, primarily regarding reportable disease and requirements for reporting to local Public Health departments, and 2 (MA and OR) describe pandemic emergency preparedness (Table 1). Despite current state and national responses to COVID-19 in long-term care settings including the exclusion of nonessential visitors, only 6 states (CO, IL, IN, KS, MA and ND) directly reference general resident isolation practices for communicable diseases within their infection control policies.