scholarly journals Clinical outcomes of SARS-CoV-2 pandemic in long-term care facilities for people with epilepsy: observational study

2020 ◽  
Author(s):  
Simona Balestrini ◽  
Matthias J Koepp ◽  
Sonia Gandhi ◽  
Hannah M Rickman ◽  
Gee Yen Shin ◽  
...  
Keyword(s):  
Long Term Care ◽  
Case Fatality ◽  
Control Measures ◽  
Care Staff ◽  
Specialist Care ◽  
Term Care ◽  
Infection Control Measures ◽  
Care Facilities ◽  
Observation Period

AbstractObjectivesCOVID-19 is spreading in long-term care facilities with devastating outcomes worldwide, especially for people with chronic health conditions. There is a pressing need to adopt effective measures prevention and containment of in such settings.DesignRetrospective cohort study assessing the effect of enhanced surveillance and early preventative strategies and comparing outcomes for people with severe epilepsy and other comorbiditiesSettingThree long-term care facilities: Chalfont Centre for Epilepsy (CCE), St. Elisabeth (STE), and The Meath (TM) with different models of primary and specialist care involvement, in the United KingdomParticipants286 long-term residents (age range 19–91 years), 740 carers who had been in contact with the residents during the observation period between 16 March and 05 June 2020.InterventionsEarly preventative and infection control measures with identification and isolation of symptomatic cases, with additional enhanced surveillance and isolation of asymptomatic residents and carers at one site (CCE)Main outcome measuresInfection rate for SARS-CoV-2 among residents and carers, asymptomatic rate and case fatality rate, if available.ResultsDuring a 12-week observation period, we identified 29 people (13 residents) who were SARS-CoV-2 positive with confirmed outbreaks amongst residents in two long-term care facilities (CCE, STE). At CCE, two out of 98 residents were symptomatic and tested positive, one of whom died. A further seven individuals testing positive on weekly enhanced surveillance had a completely asymptomatic course. One asymptomatic carer tested positive after contact with confirmed COVID-19 patients in another institution. Since 30 April 2020, during on-site weekly enhanced surveillance all 275 caregivers tested repeatedly negative. At STE, three out of 146 residents were symptomatic and tested positive, a fourth tested positive during hospital admission for symptoms not related to COVID-19. Since April 6, 2020, 105/215 carers presenting with typical symptoms for COVID-19 were tested, of whom 15 tested positive. At TM, testing of symptomatic carers only started from early/mid-April, whilst on-site testing, even of symptomatic residents, was not available until recently.During the observation period, eight of 80 residents were symptomatic but none was tested. Twenty-six of 250 carers were symptomatic and were tested, of whom two tested positive.ConclusionsInfection outbreaks in long-term care facilities for vulnerable people with epilepsy can be quickly contained, but only if asymptomatic cases are identified through enhanced surveillance at individual and care staff level. We observed a low rate of morbidity and mortality which confirmed that preventative measures with isolation of suspected and confirmed cases of COVID-19 can reduce resident-to-resident and reverse resident-to-carer transmission.

scholarly journals The role of genomics in understanding COVID-19 outbreaks in long term care facilities

2020 ◽  
Author(s):  
Dinesh Aggarwal ◽  
Richard Myers ◽  
William L. Hamilton ◽  
Tehmina Bharucha ◽  
Niamh Tumelty ◽  
...  
Keyword(s):  
Long Term Care ◽  
Control Measures ◽  
Sequencing Data ◽  
Term Care ◽  
Genomic Epidemiology ◽  
Infection Control Measures ◽  
Care Facilities ◽  
Epidemiology Studies

A review was undertaken of all genomic epidemiology studies on COVID-19 in long term care facilities (LTCF) that have been published to date. It was found that staff and residents were usually infected with identical, or near identical, SARS-CoV-2 genomes. Outbreaks usually involved one predominant lineage, and the same lineages persisted in LTCFs despite infection control measures. Outbreaks were most commonly due to single or few introductions followed by spread rather than a series of seeding events from the community into LTCFs. Sequencing of samples taken consecutively from the same cases showed persistence of the same genome sequence indicating that the sequencing technique was robust over time. When combined with local epidemiology, genomics facilitated likely transmission sources to be better characterised. Transmission between LTCFs was detected in multiple studies. The mortality rate amongst residents was high in all cases, regardless of the lineage. Bioinformatics methods were inadequate in one third of the studies reviewed, and reproducing the analyses was difficult as sequencing data were not available in many cases.

Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities

1999 ◽  
Vol 20 (05) ◽  
pp. 341-343 ◽  
Author(s):  
Christina A. Greenaway ◽  
Mark A. Miller
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Point Prevalence ◽  
Control Measures ◽  
Term Care ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Care Facilities ◽  
Vancomycin Resistant

Abstract Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.

scholarly journals Saving lives through life-threatening measures? The COVID-19 paradox of infection prevention in long-term care facilities

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ansgar Thiel ◽  
Dorothee Altmeier ◽  
Annika Frahsa ◽  
Gerhard W. Eschweiler ◽  
Andreas Nieß ◽  
...  
Keyword(s):  
Long Term Care ◽  
Control Measures ◽  
Term Care ◽  
Infection Control Measures ◽  
External Reference ◽  
Care Facilities ◽  
Life Threatening ◽  
Socially Isolated ◽  
The One

AbstractThe current SARS Cov-2 infection control measures have paradoxical effects. On the one hand, the lockdown measures help to protect vulnerable populations in particular. On the other hand, these measures inevitably have the effect that those who are to be protected not only become socially isolated and are exposed to enormous psychological stress, but also break down physically due to inactivity. Thus, the activation that is omitted in the lockdown is not compensated by external reference groups, which also indicates that important conditions for healthy ageing are not given in long-term care facilities.

scholarly journals Covid-19 infection and attributable mortality in UK Long Term Care Facilities: Cohort study using active surveillance and electronic records (March-June 2020)

2020 ◽  
Author(s):  
Peter F Dutey-Magni ◽  
Haydn Williams ◽  
Arnoupe Jhass ◽  
Greta Rait ◽  
Harry Hemingway ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Active Surveillance ◽  
Long Term Care ◽  
Case Fatality ◽  
Control Measures ◽  
Attributable Mortality ◽  
Term Care ◽  
Care Facilities

Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. We used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. We modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection. Funding: Economic and Social Research Council [ES/V003887/1].

scholarly journals Understanding contributors to quality of care in long-term care and changes under COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 960-960
Author(s):  
Sara Luck ◽  
Katie Aubrecht
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
The United States ◽  
Control Measures ◽  
Qualitative Description ◽  
Care Staff ◽  
Term Care ◽  
The Impact

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.

scholarly journals Implementation of Assistive Technologies and Robotics in Long-Term Care Facilities: A Three-Stage Assessment Based on Acceptance, Ethics, and Emotions

2021 ◽  
Vol 12 ◽  
Author(s):  
Annette Franke ◽  
Elmar Nass ◽  
Anna-Kathleen Piereth ◽  
Annabel Zettl ◽  
Christian Heidl
Keyword(s):  
Transformational Leadership ◽  
Long Term Care ◽  
Implementation Process ◽  
Well Being ◽  
Emotion Management ◽  
Assistive Technologies ◽  
Care Staff ◽  
Term Care ◽  
Care Facilities

Assistive technologies including assistive robots (AT/AR) appear to be a promising response to the increasing prevalence of older adults in need of care. An increasing number of long-term care facilities (LTCFs) try to implement AT/AR in order to create a stimulating environment for aging well and to reduce workload for professional care staff. The implementation of new technologies in an organization may lead to noticeable cultural changes in terms of social interactions and care practices associated with positive or negative emotions for the employees. This applies especially for LTCFs with high rates of vulnerable residents affected by increasing care needs and specific ethics in nursing and cultural rules within the setting. Thus, systematic consideration in leadership management of emotions and ethical aspects is essential for stakeholders involved in the implementation process. In this article, we explicitly focus on the emotions of the employees and leaders within LTCFs. We relate to direct consequences for the organizational well-being and culture, which is of course (indirectly) affecting patients and residents. While aspects of technology acceptance such as safety and usefulness are frequently discussed in academic literature, the topic of emotion-management and ethical questions during the organizational implementation process in LTCFs received little attention. Emotional culture entails affective values, ethical norms and perceptions of employees and further investigation is needed to address the importance of transformational leadership during implementation process. For this purpose, we developed a three-staged assessment tool for implementation of AT/AR in long-term care institutions. Acceptance (A), ethical acceptability (A) and emotional consequences (E) are considered as comprehensive assessment, in which emotional consequences comprise management aspects of transformational leadership (T), emotion-management (E) and organizational culture (O). Based on AAE and TEO, this paper presents an integrated framework illustrated with a illustrative example and aims to combine established approaches with ethical insights in order to unfold potentials of AT/AR in LTCSs.

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.

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.

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.

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