National Institute of Health Research (NIHR) Health Technology Assessment, NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.

Objectives The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants Residents and staff in care settings such as nursing homes and long term care facilities. Methods PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.