Understanding barriers to effective management of influenza outbreaks by residential aged care facilities

Huhtinen, Essi; Quinn, Emma; Hess, Isabel; Najjar, Zeina; Gupta, Leena

doi:10.1111/ajag.12595

Cited by 24 publications

(32 citation statements)

References 12 publications

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“…First, the ratio of health personnel/residents is generally limited and not adequate to sustain in emergency situations [123]. Second, lack of personal protective equipment, poor swab availability, absence of prompt health care guidelines to minimize the infection spread, lack of available drugs were reported in 82.7%, 46.9%, 19.9%, and 10.3% [124]. Furthermore, the imbalance between the caregiver and the number of residents is further accentuated as nursing staff are missing due to sick leave or mandatory quarantine or due to fear of working without the appropriate personal protective equipment [125].…”

Section: Nursing Homes and Palliationmentioning

confidence: 99%

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

et al. 2020

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The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viralinduced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.

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Section: Nursing Homes and Palliationmentioning

confidence: 99%

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

et al. 2020

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“…41 Facility managers can play a key role in advocating and facilitating vaccination among their staff and PHUs can support them in achieving this. 12,39,42…”

Section: Resultsmentioning

confidence: 99%

“…4,18,36,39 Despite this, review of the literature highlights slow or deficient outbreak notification and difficulties encountered by facilities in following national guidelines.…”

Section: Implications For Public Healthmentioning

confidence: 99%

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

Tennant¹,

Fletcher-Lartey

Kakar

et al. 2020

Australian and New Zealand Journal of Public Health

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Objective: To explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities.Methods: A retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017.Results: A total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p<0.001; B=0.674). Resident attack rates and resident mortality rates were lower in outbreaks notified early, on univariate analysis (p=0.034 and p=0.048 respectively) but not on an adjusted model. Staff attack rates were significantly associated with resident attack rates (p=0.001; B=0.736). Data on staff vaccination rates was incomplete and reported coverage rates were low (median 39%). Resident vaccination coverage ≥95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model. Conclusions:Early public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public health:Measures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

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“…IPC training requires additional resources but, if successful, the benefits should include less absenteeism among staff (from illness or quarantine), which has been a major contributor to high COVID-19 attack and fatality rates among RACF residents. 17 In the long term, improved prevention and control of infection in RACFs should contribute to reducing the impacts of seasonal influenza and antimicrobial resistance, 18,19 which are important causes of avoidable hospitalisation and cost in aged care.…”

Section: Embedding Infection Prevention and Control Practices Into Ramentioning

confidence: 99%

COVID ‐19 in a Sydney nursing home: a case study and lessons learnt

Gilbert

2020

Medical Journal of Australia

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Perspectives COVID-19 in a Sydney nursing home: a case study and lessons learnt Lessons learnt from COVID-19 outbreaks in residential aged care facilities could limit future impacts I nfectious disease outbreaks are a hazard of communal living in places such as military barracks, boarding schools, prisons and residential care homes. The risks are exacerbated when residents are vulnerable because of advanced age, comorbidities and frailty, or there are too few or inadequately trained staff. The home-like setting of modern residential aged care facilities (RACFs), and the overcrowding and limited staffing that are features of many, are not conducive to prevention or control of infectious diseases. 1-3 Early in the coronavirus disease 2019 (COVID-19) pandemic it was clear that age would be a risk factor. 4,5 Internationally, age-stratified case fatality rates (CFRs) have been an estimated three times higher in people aged over 60 years (4.5%) than in those aged under 60 years (1.4%). 6 In Australia, the overall CFR from COVID-19 is about 3%. 7 The majority of deaths have occurred in people over 70 years of age. At 14 September 2020, there were 1995 COVID-19 cases among residents of government-subsidised RACFs, of whom 604 (30%) died. This is in contrast to a CFR of 8.5% (7/82) among recipients of government-subsidised domiciliary aged care services. Residents of RACFs represent 74% (602/816) of all COVID-19 deaths in Australia to date. 7 Comorbidities associated with an increased risk of severe COVID-19, including diabetes, chronic kidney and cardiovascular disease, are more common among RACF residents. 8 Transmission of COVID-19 can spread silently within an RACF from someone with asymptomatic or presymptomatic infection, or atypical symptoms. 9-11 Outbreaks in RACFs, with high attack rates and CFRs, have been reported in many countries. 9,10,12-14

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Understanding barriers to effective management of influenza outbreaks by residential aged care facilities

Cited by 24 publications

References 12 publications

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

COVID ‐19 in a Sydney nursing home: a case study and lessons learnt

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