Suspected transmission of norovirus in eight long-term care facilities attributed to staff working at multiple institutions

2011 ◽  
Vol 140 (9) ◽  
pp. 1702-1709 ◽  
Author(s):  
L. M. NGUYEN ◽  
J. P. MIDDAUGH
Keyword(s):  
Long Term Care ◽  
Control Measures ◽  
Regulatory Agencies ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities ◽  
Stool Specimens ◽  
Polymerase Chain ◽  
And Control

SUMMARYThis study reports on gastroenteritis outbreaks suspected of being norovirus infections in eight long-term care facilities. A descriptive epidemiological investigation was used to depict sources of infections and control measures. Outbreaks affected 299 (31%) of 954 residents and 95 (11%) of 843 staff. Attack rates were higher in residents (range 17–55%) than staff (range 3–35%). Person-to-person spread was suspected. The case-hospitalization rate was 2·5%, and no death occurred. Eight staff members were employed at multiple affected facilities and may have introduced disease into three facilities. Thirty-two stool specimens were positive for norovirus by real-time reverse transcriptase–polymerase chain reaction or enzyme immunoassay. Sequenced specimens were closely related to GII.4 New Orleans. A concurrent Clostridium difficile outbreak was also detected at one facility. Staff members who work at multiple facilities may transmit norovirus between them. Regulatory agencies should consider precluding ill staff from working in multiple facilities during outbreaks. Guidelines to control norovirus must be applied promptly and meticulously by facilities.

scholarly journals Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012

2014 ◽  
Vol 19 (29) ◽  
Author(s):  
A S Barret ◽  
N Jourdan-da Silva ◽  
K Ambert-Balay ◽  
G Delmas ◽  
A Bone ◽  
...  
Keyword(s):  
Long Term Care ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Health Authorities ◽  
First Case ◽  
Rapid Control ◽  
Care Facilities ◽  
And Control

This article describes outbreaks of gastroenteritis in elderly long-term care facilities (LTCF) in France from November 2010 to May 2012 reported through the surveillance system for gastroenteritis outbreaks in LTCF. A total of 1,072 outbreaks were reported, causing 26,551 episodes of illness and 60 deaths. The median attack rate (AR) among residents was 32%. Norovirus and person-to-person transmission were the most frequently reported aetiology and mode of transmission. Control measures were implemented in 1,054 (98%) outbreaks and for 928 outbreaks, the timing of such measures could be inferred. Of these, 799 (86%) had put control measures into effect within three days of the occurrence of the first case. Outbreaks of gastroenteritis in LTCF cause substantial morbidity and mortality among elderly people in France. LTCF are encouraged to develop infection prevention and control plans and to notify any gastroenteritis outbreak to health authorities to ensure rapid control.

scholarly journals Early warning and rapid public health response to prevent COVID-19 outbreaks in long-term care facilities (LTCF) by monitoring SARS-CoV-2 RNA in LTCF site-specific sewage samples and assessment of antibodies response in this population: prospective study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e052282
Author(s):  
Bonita E Lee ◽  
Christopher Sikora ◽  
Douglas Faulder ◽  
Eleanor Risling ◽  
Lorie A Little ◽  
...  
Keyword(s):  
Public Health ◽  
Early Warning ◽  
Early Warning System ◽  
Long Term Care ◽  
Warning System ◽  
Control Measures ◽  
Term Care ◽  
Site Specific ◽  
Care Facilities

IntroductionThe COVID-19 pandemic has an excessive impact on residents in long-term care facilities (LTCF), causing high morbidity and mortality. Early detection of presymptomatic and asymptomatic COVID-19 cases supports the timely implementation of effective outbreak control measures but repetitive screening of residents and staff incurs costs and discomfort. Administration of vaccines is key to controlling the pandemic but the robustness and longevity of the antibody response, correlation of neutralising antibodies with commercial antibody assays, and the efficacy of current vaccines for emerging COVID-19 variants require further study. We propose to monitor SARS-CoV-2 in site-specific sewage as an early warning system for COVID-19 in LTCF and to study the immune response of the staff and residents in LTCF to COVID-19 vaccines.Methods and analysisThe study includes two parts: (1) detection and quantification of SARS-CoV-2 in LTCF site-specific sewage samples using a molecular assay followed by notification of Public Health within 24 hours as an early warning system for appropriate outbreak investigation and control measures and cost–benefit analyses of the system and (2) testing for SARS-CoV-2 antibodies among staff and residents in LTCF at various time points before and after COVID-19 vaccination using commercial assays and neutralising antibody testing performed at a reference laboratory.Ethics and disseminationEthics approval was obtained from the University of Alberta Health Research Ethics Board with considerations to minimise risk and discomforts for the participants. Early recognition of a COVID-19 case in an LTCF might prevent further transmission in residents and staff. There was no direct benefit identified to the participants of the immunity study. Anticipated dissemination of information includes a summary report to the immunity study participants, sharing of study data with the scientific community through the Canadian COVID-19 Immunity Task Force, and prompt dissemination of study results in meeting abstracts and manuscripts in peer-reviewed journals.

The vulnerability of nursing home residents to the Covid-19 pandemic

2020 ◽  
Vol 23 (2-3) ◽  
pp. 57-60 ◽  
Author(s):  
Edward H Wagner
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Nursing Home Care ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

scholarly journals Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S407-S407
Author(s):  
Kate Tyner ◽  
Regina Nailon ◽  
Sue Beach ◽  
Margaret Drake ◽  
Teresa Fitzgerald ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Long Term Care ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Facilities ◽  
And Control

Abstract Background Little is known about hand hygiene (HH) policies and practices in long-term care facilities (LTCF). Hence, we decided to study the frequency of HH-related infection control (IC) gaps and the factors associated with it. Methods The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted in-person surveys and on-site observations to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment tool for LTCF was used for on-site interviews and the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet was used for observations. Gap frequencies were calculated for questions (6 on CDC survey and 8 on CMS worksheet) representing best practice recommendations (BPR). The factors studied for the association with the gaps included LTCF bed size (BS), hospital affiliation (HA), having trained infection preventionists (IP), and weekly hours (WH)/ 100 bed spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses. Results HH-related IC gap frequencies from on-site interviews are displayed in Figure 1. Only 6 (20%) LTCF reported having all 6 BPR in place and 10 (33%) having 5 BPR. LTCF with fewer gaps (5 to 6 BPR in place) appear more likely to have HA as compared with the LTCF with more gaps but the difference didn’t reach statistical significance (37.5% vs. 7.1%, P = 0.09). When analyzed separately for each gap, it was found that LTCF with HA are more likely to have a policy on preferential use of alcohol based hand rubs than the ones without HA. (85.7%, vs. 26.1% P = 0.008). Several IC gaps were also identified during observations (Figure 2) with one of them being overall HH compliance of <80%. LTCF that have over 90% HH compliance are more likely to have higher median IP WH/100 beds dedicated towards IPCP as compared with the LTCFs with less than 90% compliance (16.4 vs. 4.4, P < 0.05). Conclusion Many HH-related IC gaps still exist in LTCF and require mitigation. Mitigation strategies may include encouraging LTCF to collaborate with IP at local acute care hospitals for guidance on IC activities and to increase dedicated IP times towards IPCP in LTCF. Disclosures All authors: No reported disclosures.

Sexual harassment from older residents at long-term care facilities: is it really part of the job?

2019 ◽  
Vol 32 (3) ◽  
pp. 325-333
Author(s):  
Feliciano Villar ◽  
Josep Fabà ◽  
Rodrigo Serrat ◽  
Montserrat Celdrán ◽  
Teresa Martínez
Keyword(s):  
Sexual Harassment ◽  
Best Practices ◽  
Long Term Care ◽  
Study Data ◽  
Nursing Assistant ◽  
Cross Sectional ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

ABSTRACTObjectives:To explore the extent to which staff members in long-term care facilities (LTCF) have experienced situations of sexual harassment, how they commonly and ideally manage the situation, and how their work position influences their responses.Design:Cross-sectional quantitative study, using the vignette technique.Method:A total of 2,196 staff-members who were currently working in Spanish LTCF participated in the study. Data were collected using a self-administered questionnaire. Questions regarding sexual harassment were analysed by a vignette that described a case of sexual harassment. Participants had to choose common and best practices for dealing with the case, and report the frequency with which they had experienced similar situations.Results:The results indicate that 29.9% of participants had experienced an episode of sexual harassment in a LTCF similar to the one presented in the vignette. Responses to the situation were diverse and there were significant differences between common and perceived best practices. Differences were also found depending on the work position of the participant (manager, technical staff or nursing assistant).Conclusions:There is a need for a fuller recognition of the sexual needs of older people. However, the presence of inappropriate sexual behavior must also be acknowledged. The right of staff to work in an environment free of harassment must be respected. The need for explicit institutional guidelines and training opportunities is discussed.

Epidemiological and genetic characteristics of norovirus outbreaks in long-term care facilities, 2003–2006

2010 ◽  
Vol 139 (2) ◽  
pp. 286-294 ◽  
Author(s):  
N. A. ROSENTHAL ◽  
L. E. LEE ◽  
B. A. J. VERMEULEN ◽  
K. HEDBERG ◽  
W. E. KEENE ◽  
...  
Keyword(s):  
Long Term Care ◽  
Laboratory Data ◽  
Case Fatality ◽  
Term Care ◽  
Genetic Characteristics ◽  
Duration Of Illness ◽  
Care Facilities ◽  
Polymerase Chain ◽  
The Impact

SUMMARYTo identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003–2006. Faecal specimens were tested for NoV by real-time reverse transcriptase–polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3·1% and a case-fatality rate of 0·5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0·001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004–2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon.

Control of Transmission of Vancomycin-Resistant Enterococcus faecium in a Long-Term–Care Facility

1999 ◽  
Vol 20 (05) ◽  
pp. 312-317 ◽  
Author(s):  
Maxine Armstrong-Evans ◽  
Margaret Litt ◽  
Margaret A. McArthur ◽  
Barbara Willey ◽  
Darlene Cann ◽  
...  
Keyword(s):  
Enterococcus Faecium ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Long Term Care Facility ◽  
Rectal Swabs ◽  
Vancomycin Resistant ◽  
And Control

AbstractObjectives:To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting.Outbreak Investigation:A strain of vancomycin-resistantEnterococcus faeciumnot previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain ofE faecium.Control Measures:Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.Outcome:Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day X 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).Conclusion:VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.

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