Assessment of Infection Prevention and Control Protocols, Procedures, and Implementation in Response to the COVID-19 Pandemic in Twenty-three Long-term Care Facilities in Fulton County, Georgia

Telford, Carson; Bystrom, Cyndra; Fox, Teresa; Wiggins-Benn, Sherry; McCloud, Meshell; Holland, David; Shah, Sarita

doi:10.1101/2020.08.13.20174466

Cited by 4 publications

(11 citation statements)

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“…A study in the US State of Georgia reported associations between worse infection control practice and larger outbreak size. 25 Overall, there are consistent associations between care home size and the presence of an outbreak, whereas other characteristics could contribute more to outbreak size once an outbreak starts.…”

Section: Time Between First and Last Confirmed Casementioning

confidence: 85%

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Burton

Bayne

Evans

et al. 2020

The Lancet Healthy Longevity

172

160

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Background COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. We aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. MethodsWe did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. We obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19related), and we analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. We calculated excess deaths (both COVID-19-related and non-COVID-19-related), which we defined as the sum of deaths over and above the historical average in the same period over the past 5 years. FindingsBetween March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3•35, 95% CI 1•99-5•63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital.Interpretation The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from our findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

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Section: Time Between First and Last Confirmed Casementioning

confidence: 85%

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Burton

Bayne

Evans

et al. 2020

The Lancet Healthy Longevity

172

160

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“…Furthermore, our intervention included outbreak measures that have been implemented to curb transmission across the United States, such as cohorting 27 and routine symptom monitoring of staff and residents, 28 universal mask policies, 29 appropriate PPE use/ensuring no PPE shortages. 30 As a result, our analysis provides additional support for the effectiveness of outbreak measures not implemented in large LTCF COVID-19 outbreaks in other jurisdictions and are comparable to recommended approaches in the United States and Canada. 2,28,[31][32][33] However, important difference exists in our approach compared to what has been reported and recommended in the United States.…”

Section: Comparison Of Related Studies In the Literaturementioning

confidence: 52%

Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities

Prairie

Otterstatter

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. Design: Quasi-experimental, segmented regression analysis. Intervention: A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. Methods: A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. Results: The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03–1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67–0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10–0.88; P < .05). Conclusions: Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.

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“…In a study of LTCFs in Fulton county, USA, social distancing and maintaining maximum occupancy limit in the facilities were statistically significantly associated with lower prevalence of COVID-19 infection (p<0.05). 12 A French study by Belmin et al also found significantly lower prevalence of COVID-19 infection among LTCF residents and staff, in addition to a lower prevalence of death among residents, when staff voluntarily confine themselves to the facilities for seven or more days (p<0.001). 10 Shallcross et al also showed that non-isolation of sick residents and non-assignment of staff to care separately for infected and uninfected residents significantly increased the risk of infections among residents and staff (p<0.001).…”

Section: Isolation and Social Distancingmentioning

confidence: 94%

“…13 A total of 14,830 long term care facilities and 864,434 residents were involved in these studies. Two studies were conducted in France 8,10 and the United States 11,12 , respectively and one was conducted in the United Kingdom. 9 The only included clinical practice guideline was developed for nursing homes in Canada 13 (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Preventing the Transmission of COVID-19 in Older Adults Aged 60 Years and Above Living in Long-Term Care: Rapid Review Update

Egunsola

Hofmeister

Dowsett

et al. 2021

Preprint

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Objectives: The objective of this study was to examine the effect of measures of control and management of COVID-19, Middle East Respiratory Syndrome (MERS), and severe acute respiratory syndrome (SARS) in adults 60 years or above living in long-term care facilities. This is an update of previous work done by Rios et al. Methods: A rapid review was conducted in accordance with the Rapid Review Guide for Health Policy and Systems Research. Literature search of databases MEDLINE, Cochrane library, and pre-print servers (biorxiv/medrxiv) was conducted from July 31, 2020 to October 9, 2020. EMBASE was searched from July 31, 2020 until October 18, 2020. Titles and abstracts from public archives were identified for screening using Gordon V. Cormack and Maura R. Grossmans Continuous Active Learning (CAL) tool, which uses supervised machine learning. Results: Five observational studies and one clinical practice guideline were identified. Infection prevention measures identified in this rapid review included: social distancing and isolation, personal protective equipment (PPE) use and hygiene practices, screening, training and staffing policies. The use of PPE, laboratory screening tests, sick pay to staff, self-confinement of staff within the LTCFs for 7 or more days, maintaining maximum resident occupancy, training and social distancing significantly reduced the prevalence of COVID-19 infection among residents and/or staff of LTCFs (p<0.05). Practices such as hiring of temporary staff, not assigning staff to care separately for infected and uninfected residents, inability to isolate sick residents and infrequent cleaning of communal areas significantly increased the prevalence of infection among residents and/or staff of LTCFs (p<0.05). Conclusion: The available studies are limited to only three countries despite the global nature of the disease. The majority of these studies showed that infection control measures such as favourable staffing policies, training, screening, social distancing, isolation and use of PPE significantly improved residents and staff related outcomes. More studies exploring the effects infection prevention and control practices in long term care facilities are required.

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Assessment of Infection Prevention and Control Protocols, Procedures, and Implementation in Response to the COVID-19 Pandemic in Twenty-three Long-term Care Facilities in Fulton County, Georgia

Abstract: Through infection prevention and control (IPC) site visits to 23 LTCFs in Fulton County, Georgia, comparison between the Higher- and Lower-prevalence groups revealed significant differences in PPE and Social Distancing, with five specific indicators driving these differences.

Cited by 4 publications

References 4 publications

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities

Preventing the Transmission of COVID-19 in Older Adults Aged 60 Years and Above Living in Long-Term Care: Rapid Review Update

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