scholarly journals 804. Infection Control and Clinical Support in Long-Term Care Homes During the COVID-19 Pandemic in North Toronto: A Quasi-Experimental Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S496-S497
Author(s):  
Maria M Magaz ◽  
Jaclyn O’Brien ◽  
Victoria R Williams ◽  
Christina Chan ◽  
Adrienne Chan ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Case Fatality ◽  
Care Homes ◽  
Protective Equipment ◽  
Term Care ◽  
Environmental Cleaning ◽  
Quasi Experimental ◽  
Congregate Care

Abstract Background Wave one of the COVID-19 pandemic in Ontario, Canada, resulted in significant institutional outbreaks associated with high case fatality among older adults. Our hospital formally partnered with congregate care homes in north Toronto to support infection control and clinical management before wave two of the COVID-19 pandemic. Our aim was to evaluate the impact of this program on resident and healthcare worker (HCW) outcomes. Methods A multicentre quasi-experimental study was conducted comparing outcomes between wave one (March-June, 2020) and wave two (October-December, 2020) among 17 congregate care homes (4 long term care homes and 13 residential homes). During wave two, weekly meetings and 42 on-site visits were conducted along with on-site daily hospital presence for all COVID-19 outbreaks to support infection control and resident management. The primary outcomes included COVID-19-case fatality rate as well as overall resident fatality including COVID-19 and non-COVID-19 related causes. Secondary outcomes included healthcare worker COVID-19 infections, and infection control practices among homes with paired audits (n=6), including hand hygiene, use of personal protective equipment, environmental cleaning and physical distancing practices. Results Among 2203 residents during wave one and 2287 residents during wave two, there was reduction in COVID-19 case fatality rate (38.1% vs. 13.4%; p< 0.01), overall COVID-19-related fatality (2.3% vs. 1.0%; p< 0.01) and non COVID-19 related fatality (8.3% vs. 3.5%; p< 0.01). Weekly staff testing and increased syndromic surveillance was implemented during wave two. Among 2590 staff, there were 2.6% vs.4.2% staff who tested positive for COVID-19 during wave one and two, respectively. Changes in infection control practice were observed in regard to directly observed hand hygiene (83.3% vs. 100%), use of personal protective equipment (16.7% vs. 83.3%), environmental cleaning (66.7% vs. 100%) and physical distancing (66.7% vs. 83.3%). Conclusion Integration of hospital with community congregate care homes was associated with improvements in resident outcomes during wave two of the pandemic. Further longitudinal support and evaluation is needed to ensure sustainability. Disclosures All Authors: No reported disclosures

The promise of transformed long-term care homes: Evidence from the pandemic

2021 ◽  
pp. 084047042110377
Author(s):  
G. Allen Power ◽  
Jennifer Carson
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Well Being ◽  
Care Homes ◽  
Term Care ◽  
Increased Risk ◽  
Disease Exposure ◽  
Green House Project ◽  
Health Experts

A combination of factors during the SARS-CoV-2 pandemic led to a disproportionately high mortality rate among residents of long-term care homes in Canada and around the globe. Retrospectively, some of these factors could have been avoided or minimized. Many infection control approaches recommended by public health experts and regulators, while well intended to keep people safe from disease exposure, threatened other vital aspects of health and well-being. Furthermore, focusing narrowly on infection control practices does not address longstanding operational and infrastructural factors that contributed significantly to the pandemic toll. In this article, we review traditional (ie institutional) long-term care practices that were associated with increased risk during the pandemic and highlight one transformational model (the Green House Project) that worked well to protect the lives and livelihood of people within congregate care settings. Drawing on this evidence, we identify specific strategies for necessary and overdue improvements in long-term care homes.

scholarly journals Investigation of a Prolonged Group A Streptococcus Outbreak Among Residents and Outpatients Receiving Wound Care at a Long-Term Care Facility (LTCF)

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s306
Author(s):  
Alana Cilwick ◽  
April Burdorf ◽  
Wendy Bamberg ◽  
Christopher Czaja ◽  
Alexis Burakoff ◽  
...  
Keyword(s):  
Infection Control ◽  
Staff Member ◽  
Long Term Care ◽  
Wound Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Group A

Background: In February 2019, the Colorado Department of Public Health and Environment (CDPHE) identified a cluster of 3 invasive group A Streptococcus (GAS) infections in residents receiving wound care in a long-term care facility (LTCF). An investigation revealed a larger outbreak that extended to nonresidents receiving outpatient wound care at the LTCF. Methods: A case was defined as a positive culture for GAS emm type 82 from an individual with exposure to the LTCF between January and June 2019. Cases were categorized as clinical (symptoms of GAS disease or GAS isolated from a wound or sterile site) or carriage (no symptoms). Carriers were identified via samples collected from throat and skin lesions. Screening occurred in 2 rounds and included residents of affected units followed by screening of all wound-care staff and residents facility-wide. Available isolates were sent for emm type testing and whole-genome sequencing (WGS) at the CDC. CDPHE staff performed infection control observations. Results: We identified 14 cases: 8 clinical and 6 carriage (from 5 residents and 1 staff member). Two patients with invasive GAS died. Of 8 patients with clinical GAS, 6 resided in the facility on or 1 day prior to symptom onset; 2 were not residents but received outpatient therapy at the LTCF. All 8 patients with clinical GAS (100%) and 3 carriers had received wound care. The staff member with emm 82 carriage had provided wound care and occupational therapy to the affected residents and the 2 outpatients. Two additional cases were detected with onset dates following staff member decolonization. Moreover, 13 of the 14 emm 82 isolates were found to be identical by WGS. Infection control observations identified lapses in staff wound care and hand hygiene practices in the residential and outpatient settings of the facility. Conclusions: This investigation details a large GAS outbreak in an LTCF associated with asymptomatic carriage in residents and staff that included patients who had only received care in the outpatient portion of the facility. The outbreak was halted following decolonization of a staff member and improvements in infection control, including in the outpatient setting. Outpatient services, particularly wound care, provided by LTCFs should be considered when investigating LTCF-related GAS cases and outbreaks.Funding: NoneDisclosures: None

scholarly journals Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 48
Author(s):  
Roger E. Thomas
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Strong Evidence ◽  
Disease Transmission ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities ◽  
Meta Analyses ◽  
Tract Infections

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

scholarly journals The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s527-s527
Author(s):  
Gabriela Andujar-Vazquez ◽  
Kirthana Beaulac ◽  
Shira Doron ◽  
David R Snydman
Keyword(s):  
Public Health ◽  
Pilot Study ◽  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Medical Center ◽  
Term Care ◽  
Care Facilities ◽  
The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

Assistive technologies that support social interaction in long-term care homes

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marilyn Macdonald ◽  
Ziwa Yu ◽  
Lori E. Weeks ◽  
Elaine Moody ◽  
Beth Wilson ◽  
...  
Keyword(s):  
Social Interaction ◽  
Long Term Care ◽  
Assistive Technologies ◽  
Care Homes ◽  
Term Care

Discharge of pharmaceuticals into municipal sewers from hospitals and long-term care facilities

2012 ◽  
Vol 47 (2) ◽  
pp. 140-152 ◽  
Author(s):  
Muhammad Riaz ul Haq ◽  
Chris Metcalfe ◽  
Hongxia Li ◽  
Wayne Parker
Keyword(s):  
Long Term Care ◽  
Treatment Plant ◽  
Biological Response ◽  
Care Homes ◽  
Pharmaceutically Active Compounds ◽  
Term Care ◽  
Healthcare Facilities ◽  
Antibiotic Compounds ◽  
Composite Samples

The presence of pharmaceutically active compounds in the aquatic environment has become well established, and their presence is of potential concern because they are designed to produce biological response in the target receptor, may bear intrinsic toxicity (e.g. cytostatic agents, antibiotics) and they possess the potential to foster and maintain drug resistance. For both risk assessment and risk management purposes, it is important to identify the major sources of pharmaceuticals in the environment. Healthcare facilities may be major sources of the discharges of these compounds into municipal sewers. In this study, we investigated the contributions to the wastewater treatment plant (WWTP) influents from two hospitals and two long-term care homes of nine compounds. Twenty-four hour composite samples were collected over 5 consecutive days from the effluents of these facilities. The WWTPs receiving sewage from these facilities were also sampled on the same days to facilitate mass balance calculations. The results showed that the healthcare facilities contributed a greater proportion of the antibiotic compounds to the WWTPs than the other target compounds; with maximum contributions of ciprofloxacin by hospitals and long-term care homes of 26.7 and 37%, respectively.

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