scholarly journals Norovirus outbreaks in long-term care facilities. Catalonia, 2017-2018

2021 ◽  
Author(s):  
Ignacio Parrón ◽  
Irene Barrabeig ◽  
Miquel Alseda ◽  
Cristina Rius ◽  
Thais Cornejo-Sánchez ◽  
...  
Keyword(s):  
Attack Rate ◽  
Long Term Care ◽  
Control Measures ◽  
Viral Gastroenteritis ◽  
Term Care ◽  
Viral Loads ◽  
Presenting Symptoms ◽  
Asymptomatic Patients ◽  
Care Facilities

Abstract Norovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centres, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR), rate ratios (RR) or the odds ratio (OR) and its 95% confidence intervals were calculated. The mean cycle thresholds (Cq) were compared using the t-test for independent means. We included 30 outbreaks (4,631 exposed people). The global AR was 25.9%. The RR of residents vs. staff was 2.28 (95%CI 2.0-2.6). In residents with total or severe dependence the attack rate was 85.16% and in residents with moderate and low dependence or independent was 69.13% (RR 1.23, 95% CI 1.05–1.45). ARs were higher in smaller centres than in larger ones (34.4% vs 19.5%; RR 1.76 (95%CI 1.60–1.94). GII was responsible for 70% of outbreaks and 78.5% of identifications. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41 to 2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001). Because norovirus was detected in asymptomatic persons, control measures should be applied not only to people with symptoms but to all persons in LTCF where norovirus outbreaks occur.

scholarly journals Norovirus outbreaks in long-term care facilities in Catalonia from 2017 to 2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ignacio Parrón ◽  
Irene Barrabeig ◽  
Miquel Alseda ◽  
Cristina Rius ◽  
Thais Cornejo-Sánchez ◽  
...  
Keyword(s):  
Long Term Care ◽  
Viral Gastroenteritis ◽  
Term Care ◽  
Viral Loads ◽  
Presenting Symptoms ◽  
Asymptomatic Patients ◽  
Care Facilities ◽  
Mean Cycle ◽  
Acute Viral Gastroenteritis

AbstractNorovirus is the leading cause of outbreaks of acute viral gastroenteritis. We carried out this study to investigate outbreaks in long-term care facilities reported in 2017 and 2018 in Catalonia (Spain). The characteristics of the centers, exposed persons and the genogroups responsible were analyzed. Viral loads were estimated. The attack rate (AR) of the outbreaks studied, and the rate ratio (RR) and the odds ratio (OR) and their 95% confidence intervals as measures of association were calculated. The mean cycle thresholds were compared using the t-test for independent means. We included 30 outbreaks (4631 exposed people). The global AR was 25.93%. The RR of residents vs. staff was 2.28 (95% CI 2.0–2.6). The RR between AR in residents with total or severe dependence vs. residents with moderate, low or no-dependence was 1.23 (95% CI 1.05–1.45). The AR were higher in smaller centers than in larger ones (38.47% vs. 19.25% and RR 2; 95% CI 1.82–2.2). GII was responsible for 70% of outbreaks. No association was found between the genogroup and presenting symptoms (OR 0.96; 95% CI 0.41–2.26). Viral loads were higher in symptomatic than in asymptomatic patients (p = 0.001).

scholarly journals Increasing risk of breakthrough COVID-19 in outbreaks with high attack rates in European long-term care facilities, July to October 2021

2021 ◽  
Vol 26 (49) ◽  
Author(s):  
Carl Suetens ◽  
Pete Kinross ◽  
Pilar Gallego Berciano ◽  
Virginia Arroyo Nebreda ◽  
Eline Hassan ◽  
...  
Keyword(s):  
Attack Rate ◽  
Long Term Care ◽  
Control Measures ◽  
Outbreak Detection ◽  
Infection Prevention And Control ◽  
Adjusted Relative Risk ◽  
Term Care ◽  
Care Facilities ◽  
Prevention And Control Measures

We collected data from 10 EU/EEA countries on 240 COVID-19 outbreaks occurring from July−October 2021 in long-term care facilities with high vaccination coverage. Among 17,268 residents, 3,832 (22.2%) COVID-19 cases were reported. Median attack rate was 18.9% (country range: 2.8–52.4%), 17.4% of cases were hospitalised, 10.2% died. In fully vaccinated residents, adjusted relative risk for COVID-19 increased with outbreak attack rate. Findings highlight the importance of early outbreak detection and rapid containment through effective infection prevention and control measures.

scholarly journals Characterization and evolution of infection control practices among SARS-CoV-2 infected healthcare workers of acute care hospitals and long-term care facilities in Quebec, Canada, Spring 2020

2021 ◽  
pp. 1-37
Author(s):  
Sara Carazo ◽  
Denis Laliberté ◽  
Jasmin Villeneuve ◽  
Richard Martin ◽  
Pierre Deshaies ◽  
...  
Keyword(s):  
Acute Care ◽  
Attack Rate ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Exposure Period ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Facilities

ABSTRACT Objectives: To estimate the SARS-CoV-2 infection rate and the secondary attack rate among healthcare workers (HCWs) in Quebec, the most affected province of Canada during the first wave; to describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and to compare the exposures and practices between acute care hospitals (ACHs) and long-term care facilities (LTCFs). Design: Survey of cases Participants: Quebec HCWs from private and public institutions with laboratory-confirmed COVID-19 diagnosed between 1st March and 14th June 2020. HCWs ≥18 years old, having worked during the exposure period and survived their illness were eligible for the survey. Methods: After obtaining consent, 4542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs. Results: HCWs represented 25% (13,726/54,005) of all reported COVID-19 cases in Quebec and had an 11-times greater rate than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants, working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs of LTCFs had less training, higher staff mobility between working sites, similar PPE use but better self-reported compliance with at-work physical distancing. Sub-optimal IPC practices declined over time but were still present at the end of the first wave. Conclusion: Quebec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

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.

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 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 Risk factors associated with SARS-CoV-2 infection and outbreaks in Long Term Care Facilities in England: a national survey

2020 ◽  
Author(s):  
Laura Shallcross ◽  
Danielle Burke ◽  
Owen Abbott C Stat ◽  
Alasdair Donaldson ◽  
Gemma Hallatt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Control ◽  
Long Term Care ◽  
Control Measures ◽  
Poor Compliance ◽  
Cross Sectional ◽  
Term Care ◽  
Staffing Ratios ◽  
Care Facilities

AbstractBackgroundOutbreaks of SARS-CoV-2 have occurred worldwide in Long Term Care Facilities (LTCFs), but the reasons why some facilities are particularly vulnerable to infection are poorly understood. We aimed to identify risk factors for SARS-CoV-2 infection and outbreaks in LTCFs.MethodsCross-sectional survey of all LTCFs providing dementia care or care to adults >65 years in England with linkage to SARS-CoV-2 test results. Exposures included: LTCF characteristics, staffing factors, and use of disease control measures. Main outcomes included risk factors for infection and outbreaks, estimated using multivariable logistic regression, and survey and test-based weighted estimates of SARS-CoV-2 prevalence.Findings5126/9081 (56%) LTCFs participated in the survey, with 160,033 residents and 248,594 staff. The weighted period prevalence of infection in residents and staff respectively was 10.5% (95% CI: 9.9-11.1%) and 3.8% (95%: 3.4-4.2%) and 2724 LTCFs (53.1%) had ≥1 infection. Odds of infection and/or outbreaks were reduced in LTCFs that paid sickness pay, cohorted staff, did not employ agency staff and had higher staff to resident ratios. Higher odds of infection and outbreaks were identified in facilities with more admissions, lower cleaning frequency, poor compliance with isolation and “for profit” status.InterpretationHalf of LTCFs had no cases suggesting they remain vulnerable to outbreaks. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with isolation.FundingUK Government Department of Health & Social CareResearch in contextEvidence before this studyCOVID-19 outbreaks have occurred worldwide in long-term care facilities (LTCFs), which provide care to elderly and vulnerable residents, and are associated with high mortality. The reasons why LTCFs are particularly vulnerable to COVID-19 are poorly understood. Most studies of risk factors for COVID-19 to date have been limited by scale, and poor quality administrative, demographic and infection control data. We conducted a systematic search on 27 July 2020 in MEDLINE Ovid, WHO COVID-19 database and in MedRxiv to identify studies reporting risk factors for COVID-19 infection or outbreaks in LTCFs, with no date or language restrictions. We used the search terms “COVID-19”, “SARS-CoV-2”, “coronavirus” and “care home”, “nursing home”, “long term care facilit” and excluded studies that did not investigate LTCF-level risk factors. 14 studies met our inclusion criteria comprising 11 cross-sectional studies and 3 surveys. The largest cross-sectional study was conducted in 9395 specialised nursing facilities across 30 states in USA; the largest survey was conducted in 124 LTCFs in Haute-Garrone region of France. Risk of bias was high across all studies, and results could not be pooled due to heterogeneity between studies. Main risk factors for infection and/or outbreaks related to the size of the facility, lower ratios of staff to residents, urban location, higher occupancy, and the community prevalence of infection. Only one study collected data on the use of disease control measures during the pandemic, and no studies provided data on risk factors such as the use of temporary staff, or the impact of staff working across multiple locations.Added value of this studyWe conducted a national telephone survey with managers of all LTCFs in England which provided dementia care or care to residents aged > 65 years to collect data on the number of staff and residents in each facility, confirmed SARS-CoV-2 infections, characteristics of the facility e.g.size, staffing (use of temporary staff, staffing ratios, sickness pay) and disease control measures such as cohorting and isolation. We identified risk factors for infection in residents and staff, outbreaks (defined as ≥1 case per LTCF) and large outbreaks using logistic regression. We also estimated the proportion of staff and residents who had been infected with SARS-CoV-2. Responses were obtained from 5126 of out 9081 (56%) of eligible LTCFs. To our knowledge, this is the largest and most detailed survey of risk factors for SARS-CoV-2 infection and outbreaks that has been conducted in LTCFs.Implications of all the available evidenceAlmost half of LTCFs surveyed in this study did not report any cases of infection, and remain vulnerable to infection and outbreaks, highlighting the need for effective control measures. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with control measures such as isolation.

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