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.

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

Improving the Fate of Nursing Homes During the COVID-19 Pandemic: The Need for Policy

2021 ◽  
pp. e1-e3
Author(s):  
R. Tamara Konetzka
Keyword(s):  
Public Health ◽  
United States ◽  
New York ◽  
Nursing Homes ◽  
Long Term Care ◽  
New York Times ◽  
The United States ◽  
Term Care ◽  
Care Facilities

Approximately 40% of all COVID-19 deaths in the United States have been linked to long-term care facilities.1 Early in the pandemic, as the scope of the problem became apparent, the nursing home sector generated significant media attention and public alarm. A New York Times article in mid-April referred to nursing homes as “death pits”2 because of the seemingly uncontrollable spread of the virus through these facilities. This devastation continued during subsequent surges,3 but there is a role for policy to change this trajectory. (Am J Public Health. Published online ahead of print January 28, 2021: e1–e3. https://doi.org/10.2105/AJPH.2020.306107 )

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 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.

scholarly journals COVID-19 Across the Landscape of Long-Term Care in Alameda County: Heterogeneity and Disparities

2022 ◽  
Vol 8 ◽  
pp. 233372142110734
Author(s):  
Terry E. Hill ◽  
David J. Farrell
Keyword(s):  
Public Health ◽  
Long Term Care ◽  
The Elderly ◽  
Population Based ◽  
Nursing Facilities ◽  
Term Care ◽  
Skilled Nursing ◽  
Data Infrastructure ◽  
Care Facilities

Throughout the pandemic, public health and long-term care professionals in our urban California county have linked local and state COVID-19 data and performed observational exploratory analyses of the impacts among our diverse long-term care facilities (LTCFs). Case counts from LTCFs through March 2021 included 4309 (65%) in skilled nursing facilities (SNFs), 1667 (25%) in residential care facilities for the elderly (RCFEs), and 273 (4%) in continuing care retirement communities (CCRCs). These cases led to 582 COVID-19 resident deaths and 12 staff deaths based on death certificates. Data on decedents’ age, race, education, and country of birth reflected a hierarchy of wealth and socioeconomic status from CCRCs to RCFEs to SNFs. Mortality rates within SNFs were higher for non-Whites than Whites. Staff accounted for 42% of LTCF-associated COVID-19 cases, and over 75% of these staff were unlicensed. For all COVID-19 deaths in our jurisdiction, both LTCF and community, 82% of decedents were age 65 or over. Taking a comprehensive, population-based approach across our heterogenous LTCF landscape, we found socioeconomic disparities within COVID-19 cases and deaths of residents and staff. An improved data infrastructure linking public health and delivery systems would advance our understanding and potentiate life-saving interventions within this vulnerable ecosystem.

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 Preventing COVID-19 spread in closed facilities by regular testing of employees—An efficient intervention in long-term care facilities and prisons?

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249588
Author(s):  
Henri Christian Junior Tsoungui Obama ◽  
Nessma Adil Mahmoud Yousif ◽  
Looli Alawam Nemer ◽  
Pierre Marie Ngougoue Ngougoue ◽  
Gideon Akumah Ngwa ◽  
...  
Keyword(s):  
Long Term Care ◽  
Risk Group ◽  
Herd Immunity ◽  
Risk Groups ◽  
Control Measures ◽  
Term Care ◽  
Care Facilities ◽  
Public Health Authorities ◽  
The U.S

Background Different levels of control measures were introduced to contain the global COVID-19 pandemic, many of which have been controversial, particularly the comprehensive use of diagnostic tests. Regular testing of high-risk individuals (pre-existing conditions, older than 60 years of age) has been suggested by public health authorities. The WHO suggested the use of routine screening of residents, employees, and visitors of long-term care facilities (LTCF) to protect the resident risk group. Similar suggestions have been made by the WHO for other closed facilities including incarceration facilities (e.g., prisons or jails), wherein parts of the U.S., accelerated release of approved inmates is taken as a measure to mitigate COVID-19. Methods and findings Here, the simulation model underlying the pandemic preparedness tool CovidSim 1.1 (http://covidsim.eu/) is extended to investigate the effect of regularly testing of employees to protect immobile resident risk groups in closed facilities. The reduction in the number of infections and deaths within the risk group is investigated. Our simulations are adjusted to reflect the situation of LTCFs in Germany, and incarceration facilities in the U.S. COVID-19 spreads in closed facilities due to contact with infected employees even under strict confinement of visitors in a pandemic scenario without targeted protective measures. Testing is only effective in conjunction with targeted contact reduction between the closed facility and the outside world—and will be most inefficient under strategies aiming for herd immunity. The frequency of testing, the quality of tests, and the waiting time for obtaining test results have noticeable effects. The exact reduction in the number of cases depends on disease prevalence in the population and the levels of contact reductions. Testing every 5 days with a good quality test and a processing time of 24 hours can lead up to a 40% reduction in the number of infections. However, the effects of testing vary substantially among types of closed facilities and can even be counterproductive in U.S. IFs. Conclusions The introduction of COVID-19 in closed facilities is unavoidable without a thorough screening of persons that can introduce the disease into the facility. Regular testing of employees in closed facilities can contribute to reducing the number of infections there, but is only meaningful as an accompanying measure, whose economic benefit needs to be assessed carefully.

scholarly journals Epidemiology and Management of Seasonal Influenza Outbreaks in Long-Term Care Facilities in the Health Service Executive East Area of Ireland During the 2013-2014 Influenza Season

2017 ◽  
Vol 1 (1) ◽  
pp. 22-32 ◽  
Author(s):  
L. O’Connor ◽  
H. Murphy ◽  
E. Montague ◽  
M. Boland
Keyword(s):  
Public Health ◽  
Seasonal Influenza ◽  
Long Term Care ◽  
Influenza Season ◽  
Term Care ◽  
Health Service Executive ◽  
Outbreak Management ◽  
Vaccination Rates ◽  
Care Facilities

We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.

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