scholarly journals Direct and indirect effectiveness of mRNA vaccination against SARS-CoV-2 infection in long-term care facilities in Spain

2021 ◽  
Author(s):  
Susana Monge ◽  
Carmen Olmedo ◽  
Belen Alejos ◽  
Marife Lapena ◽  
Maria Jose Sierra ◽  
...  
Keyword(s):  
Long Term Care ◽  
Cumulative Risk ◽  
Vaccine Dose ◽  
Reproductive Number ◽  
Term Care ◽  
Care Facilities ◽  
Previous Infection ◽  
Indirect Protection

Objectives: To estimate indirect and total (direct plus indirect) effects of COVID-19 vaccination in residents in long-term care facilities (LTCF). Design: Registries-based cohort study including all residents in LTCF 65 years or older offered vaccination between 27 December 2020 and 10 March 2021. Risk of SARS-CoV-2 infection following vaccination was compared with the risk in the same individuals in a period before vaccination. Risk in non-vaccinated was also compared to a period before the vaccination programme to estimate indirect protection. Standardized cumulative risk was computed adjusted by previous documented infection (before the start of follow-up) and daily-varying SARS-CoV-2 incidence and reproductive number. Participants: 573,533 records of 299,209 individuals in the National vaccination registry were selected; 99.0% had received at least 1 vaccine-dos, 99.8% was Pfizer/BioNTech (BNT162b2). Residents mean age was 85.9, 70.9% were females. A previous SARS-CoV-2 infection was found in around 25% and 13% of participants, respectively, at the time of vaccine offer and in the reference period. Main outcome measures: Documented SARS-CoV-2 infection identified in the National COVID-19 laboratory registry. Results: Total VE was 57.2% (95% Confidence Interval: 56.1%-58.3%), and was highest starting 28 days after the first vaccine-dose (proxy of more than 7 days after the second dose) and for individuals naive to SARS-CoV-2 [81.8% (81.0%-82.7%)] compared to those with previous infection [56.8% (47.1%-67.7%)]. Vaccination prevented up to 9.6 (9.3-9.9) cases per 10.000 vaccinated per day; 11.6 (11.3-11.9) if naive vs. 0.8 (0.5-1.0) if previous infection. Indirect protection in the non-vaccinated could only be estimated for naive individuals, at 81.4% (73.3%-90.3%) and up to 12.8 (9.4-16.2) infections prevented per 10.000 indirectly protected per day. Conclusions: Our results confirm the effectiveness of mRNA vaccination in institutionalized elderly population, endorse the policy of universal vaccination in this setting, including in people with previous infection, and suggest that even non-vaccinated individuals benefit from indirect protection.

scholarly journals 1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S375-S376
Author(s):  
Teresa Fitzgerald ◽  
Regina Nailon ◽  
Kate Tyner ◽  
Sue Beach ◽  
Margaret Drake ◽  
...  
Keyword(s):  
Infection Control ◽  
Best Practice ◽  
Long Term Care ◽  
Audit And Feedback ◽  
Risk Assessments ◽  
Term Care ◽  
Practice Recommendations ◽  
Care Facilities

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.

Pharmacoepidemiology of Urinary Tract Infections in Iowa Medicaid Patients in Urban Long-Term-Care Facilities

1997 ◽  
Vol 31 (7-8) ◽  
pp. 837-841 ◽  
Author(s):  
Darrel C. Bjornson ◽  
John P. Rovers ◽  
Julie A. Burian ◽  
Nancy L. Hall
Keyword(s):  
Urinary Tract ◽  
Patient Outcomes ◽  
Urinary Tract Infections ◽  
Long Term Care ◽  
Treatment Preference ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

OBJECTIVE: To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes. DESIGN: Retrospective review of medical records in LTCFs of patients who had documented UTIs. METHODS: Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995. Patients with UTIs were selected from the LTCF infection control logs. Data collected on patients included demographics, concomitant diseases, type of UTI (i.e., symptomatic, asymptomatic, catheter-related), process measures for management, UTI treatment, patient outcomes, and follow-up. Patient outcome data were defined as either cure or no cure. A UTI cure was defined as a negative urine culture while taking antibiotic therapy and/or complete resolution of signs and symptoms, as well as no further treatment given within 2 weeks after the end of treatment. RESULTS: Data were collected on 310 patients who had at least one UTI over the 1-year study period. Patients were primarily elderly (mean age 82.2 ± 12.3 y), white (95.1%), and female (83.9%). Concomitant diseases were common and about one-fourth (23.0%) of the patients were catheterized. There were 536 UTI events (the unit of analysis) documented over the 1-year period, with about one-half (45.9%) being UTIs with symptoms consistent with uncomplicated lower UTI. Nearly two-thirds (62.3%) of the patients were cured, based on the study definition; there was no association between cure and type of antimicrobial therapy (p = 0.99). Over one-third (35.2%) of the UTIs were treated with a quinolone antibiotic. Others were treated with trimethoprim/sulfamethoxazole (24.4%), nitrofurantoin (13.9%), a cephalosporin (10.4%), or ampicillin/amoxicillin (9.8%). Sixty-day follow-up showed no association between type of therapy and hospital readmission, physician follow-up visits, or subsequent UTIs. CONCLUSIONS: There were no differences in cure rates when comparing LTCF UTI patients receiving various regimens. With outcomes being the same, the clinician should closely consider costs of drug therapy in selecting a treatment preference.

scholarly journals Robust SARS-CoV-2-specific and heterologous immune responses after natural infection in elderly residents of Long-Term Care Facilities

2021 ◽  
Author(s):  
Gokhan Tut ◽  
Tara Lancaster ◽  
Megan S Butler ◽  
Panagiota Sylla ◽  
Eliska Spalkova ◽  
...  
Keyword(s):  
Long Term Care ◽  
Natural Infection ◽  
Age Groups ◽  
Vaccine Strategy ◽  
Term Care ◽  
Humoral And Cellular Immunity ◽  
Care Facilities ◽  
Previous Infection ◽  
Comparable Activity

Long term care facilities (LTCF) provide residential and/or nursing care support for frail and elderly people and many have suffered from a high prevalence of SARS-CoV-2 infection. Although mortality rates have been high in LTCF residents there is little information regarding the features of SARS-CoV-2-specific immunity after infection in this setting or how this may influence immunity to other infections. We studied humoral and cellular immunity against SARS-CoV-2 in 152 LTCF staff and 124 residents over a prospective 4-month period shortly after the first wave of infection and related viral serostatus to heterologous immunity to other respiratory viruses and systemic inflammatory markers. LTCF residents developed high levels of antibodies against spike protein and RBD domain which were stable over 4 months of follow up. Nucleocapsid-specific responses were also elevated in elderly donors but showed waning across all populations. Antibodies showed stable and equivalent levels of functional inhibition against spike-ACE2 binding in all age groups with comparable activity against viral variants of concern. SARS-CoV-2 seropositive donors showed high levels of antibodies to other beta-coronaviruses but serostatus did not impact humoral immunity to influenza or RSV. SARS-CoV-2-specific cellular responses were equivalent across the life course but virus-specific populations showed elevated levels of activation in older donors. LTCF residents who are survivors of SARS-CoV-2 infection thus show robust and stable immunity which does not impact responses to other seasonal viruses. These findings augur well for relative protection of LTCF residents to re-infection. Furthermore, they underlie the potent influence of previous infection on the immune response to Covid-19 vaccine which may prove to be an important determinant of future vaccine strategy.

[PP.03.10] MORTALITY RISK AMONG DISABLED ELDERLY RESIDENTS OF LONG TERM CARE FACILITIES DURING ONE YEAR FOLLOW-UP

2017 ◽  
Vol 35 ◽  
pp. e110
Author(s):  
B. Gryglewska ◽  
A. Kantoch ◽  
J. Wojkowska-Mach ◽  
P. Heczko ◽  
T. Grodzicki
Keyword(s):  
Mortality Risk ◽  
Long Term Care ◽  
Term Care ◽  
Disabled Elderly ◽  
Care Facilities ◽  
One Year

scholarly journals Effectiveness of BNT162b2 mRNA COVID-19 vaccine against acquisitions of SARS-CoV-2 among health care workers in long-term care facilities: a prospective cohort study

2021 ◽  
Author(s):  
Khitam Muhsen ◽  
Nimrod Maimon ◽  
Ami Mizrahi ◽  
Omri Bodenneimer ◽  
Dani Cohen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Cumulative Incidence ◽  
Long Term Care ◽  
Rt Pcr ◽  
Term Care ◽  
Care Workers ◽  
Care Facilities

Abstract Objective We assessed vaccine effectiveness (VE) of BNT162b2 mRNA COVID-19 vaccine against SARS-CoV-2 acquisition among health care workers (HCWs) of long-term care facilities (LTCFs). Methods This prospective study, in the framework of "Senior Shield" program in Israel, included routine, weekly nasopharyngeal SARS-CoV-2 RT-PCR testing from all LTCF HCWs since July 2020. All residents and 75% of HCWs were immunized between December 2020 and January 2021. The analysis was limited to HCWs adhering to routine testing. Fully vaccinated (14+ days after second dose; n=6960) and unvaccinated HCWs (n=2202) were simultaneously followed until SARS-CoV-2 acquisition, or end of follow-up, April 11, 2021. Hazard ratios (HRs) for vaccination vs. no vaccination were calculated (Cox proportional hazards regression models, adjusting for socio-demographics and residential-area COVID-19 incidence). VE was calculated as [(1– HR)×100]. RT-PCR cycle threshold values (Cts) were compared between vaccinated and unvaccinated HCWs. Results At >14 days post second dose, 40 vaccinated HCWs acquired SARS-CoV-2 (median follow-up, 66 days; cumulative incidence 0.6%) vs. 84 unvaccinated HCWs (median follow-up 43 days; cumulative incidence, 5.1%); HR=0.11 (95% CI 0.07, 0.17), unadjusted VE=89% (95% CI 83%, 93%). Adjusted VE beyond seven days and >14 days post second dose were similar. The median PCR Cts targeting ORF1ab gene among 20 vaccinated and 40 unvaccinated HCWs was 32.0 vs. 26.7, respectively, p=0.008. Conclusions VE following two doses of BNT162b2 against SARS-CoV-2 acquisition in LTCF HCWs was high. The lower viral loads among SARS-CoV-2 positive HCWs suggests further reduction in transmission.

scholarly journals The Effects of an Advanced Movable Restraint Design on the Elderly Residents at Long-Term Care Facilities in Taiwan

2018 ◽  
Vol 14 (33) ◽  
pp. 104
Author(s):  
Meng-Ping Wu ◽  
Lee-Ing Tsao
Keyword(s):  
Long Term Care ◽  
Muscle Power ◽  
The Elderly ◽  
Control Group ◽  
Exercise Frequency ◽  
Term Care ◽  
Care Facilities ◽  
Experimental Group

Purpose: The purpose of this study was to evaluate the effects, both initially and after 6 months, of an “advanced movable restraint” with openended palm sleeve restraint bands for the elderly residents at long-term care facilities in northern Taiwan. Background. Elderly residents in long-term care facilities are often forced to remain bed-ridden by traditional bed restraint bands due to their irritable, confused conditions and the associated risks of self-extubating their nasogastric (NG) tubes, urinary catheters, etc. However, the traditional bed restraint bands can themselves lead to further physical and mental complications such as skin damage, depression, hostility, and even rhabdomyolysis, increasing the risk of death. Design. Quasiexperimental design. Methods: This parallel-design study was conducted with elderly residents at eight long-term care facilities. The newly designed advanced movable restraint featuring movable open-ended palm sleeve restraint bands was applied to the elderly residents in the experimental group, allowing them greater freedom of movement such that they were not required to remain bed-ridden. In contrast, the elderly residents in the control group were restrained with traditional bed restraints requiring that they remain bedridden. The following four instruments and indicators were then used to compare the effects of the two types of restraints: (1) an activities of daily living (ADL) survey based on the Barthel Index, (2) a muscle power test, (3) an exercise frequency and duration survey, and (4) self-extubation rates. The effects of the interventions were tested by using the t test or chi-square test to compare pre-test results for the ADL survey, muscle power test, exercise frequency and duration survey, and self-extubation rates to those at a 6-month follow-up. Results: A total of 80 elderly residents were included in the experimental group, while 80 elderly residents were included in the control group. At the 6-month follow-up, the residents restrained with the advanced movable restraint had a significantly increased mean muscle power score (χ2 =17.212, P < 0.001), significantly decreased self-extubation rate (χ2 =40.733, P < .001), and significantly increased exercise frequency and duration per week (χ2=27.095 P < 0.001; 26.241 P < 0.001). Conclusions: This study showed that the advanced movable restraint can improve muscle power scores, self-extubation rates, and exercise frequencies and durations by allowing residents greater freedom of movement without the need to remain bed-ridden. It is thus crucial to use such advanced movable restraints and develop standardized technology systems to support the elderly residents and nurses in long-term care facilities.

scholarly journals Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of Long-Term Care Facilities (VIVALDI study)

2021 ◽  
Author(s):  
Madhumita Shrotri ◽  
Maria Krutikov ◽  
Tom Palmer ◽  
Rebecca Giddings ◽  
Borscha Azmi ◽  
...  
Keyword(s):  
Long Term Care ◽  
Proportional Hazards ◽  
Vaccine Dose ◽  
Cox Proportional Hazards ◽  
Protective Effects ◽  
Term Care ◽  
Department Of Health ◽  
Health And Social Care ◽  
Care Facilities

Background The effectiveness of SARS-CoV-2 vaccines in frail older adults living in Long-Term Care Facilities (LTCFs) is uncertain. We estimated protective effects of the first dose of ChAdOx1 and BNT162b2 vaccines against infection in this population. Methods Cohort study comparing vaccinated and unvaccinated LTCF residents in England, undergoing routine asymptomatic testing (8 December 2020 - 15 March 2021). We estimated the relative hazard of PCR-positive infection using Cox proportional hazards regression, adjusting for age, sex, prior infection, local SARS-CoV-2 incidence, LTCF bed capacity, and clustering by LTCF. Results Of 10,412 residents (median age 86 years) from 310 LTCFs, 9,160 were vaccinated with either ChAdOx1 (6,138; 67%) or BNT162b2 (3,022; 33%) vaccines. A total of 670,628 person days and 1,335 PCR-positive infections were included. Adjusted hazard ratios (aHRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days following the first vaccine dose to 0.44 (0.24, 0.81) at 28-34 days and 0.38 (0.19, 0.77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (aHR 0.32 [0.15-0.66] and BNT162b2 (aHR 0.35 [0.17, 0.71]) vaccines at 35-48 days. Mean PCR cycle threshold values were higher, implying lower infectivity, for infections 28 or more days post-vaccination compared with those prior to vaccination (31.3 vs 26.6, p<0.001). Interpretation The first dose of BNT162b2 and ChAdOx1 vaccines was associated with substantially reduced SARS-CoV-2 infection risk in LTCF residents from 4 weeks to at least 7 weeks. Funding UK Government Department of Health and Social Care.

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