COVID-19 testing in English care homes and implications for staff and residents

Abstract

Introduction Care home residents are at high risk of dying from COVID-19. Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods Ten staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within, and needs arising from, current pathways. Results Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure, and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.

Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes— a qualitative study

“…The interview guide consisted of questions that began with general questions before focusing on the study’s key objectives of exploring staff members’ experiences of working with the LFDs and their attitudes towards integrating these devices into their workflow. The development of the interview guide was informed by prior research conducted by members of the study team on SARS-CoV-2 testing [ 33 , 34 ], and informal discussions with staff from various care homes to identify points of criticality which had a bearing on the adoption of LFDs. We piloted the guide with a clinician who has experience working with medical diagnostics and this aided refinement of our questions concerning device usability.…”

COVID-19 point-of-care testing in care homes: what are the lessons for policy and practice?

“…Tests generate complex workflows that include detailed preparation and reporting. These are different in care homes than in hospitals or primary care settings [ 12 ]. As with all innovations, staff and residents must value and trust a test result sufficiently to prioritise conducting it when faced with competing demands [ 13 ].…”

Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study

“…PCR testing has been affected by delays in testing and reporting, creating windows in which infected individuals were not identified and could spread the virus, or leading to unnecessary isolation of residents and staff [ 7 ]. Deployment of rapid on-site tests could improve the speed and scale of testing.…”

“…Deployment of rapid on-site tests could improve the speed and scale of testing. Such tests need not only to be sufficiently accurate but also rapid, safe to use outside a laboratory [ 8 ], easy to administer and fit with the IPC workflow of the care home [ 7 ]. Antigen-based lateral flow devices (LFDs) have been deployed nationally in care homes, but not yet evaluated in an end-to-end workflow context.…”