COVID-19 Data Shows Strategies to Curb Future Outbreaks at Long-Term Care Facilities

Increased resident density, a lack of restrictions on staff movement, and mechanical recirculation of air were found to be associated with outbreaks of COVID-19 infection among residents in long-term care facilities (LTCFs). These study results were published in International Journal of Infectious Diseases.

This retrospective cohort study was conducted between September 2020 and June 2021 at 60 LTCFs. The LTCFs comprised 5600 residents and 298 wards. Researchers assessed associations between facility- and ward-level factors and outbreaks of COVID-19 infection. Data for this analysis were divided into 3 time periods, including September to October (period 1) and November to December (period 2) 2020, and from January to June 2021 (period 3. Of note, COVID-19 vaccines were available only in period 3. Multivariate logistic regression was used to determine associations between facility- and ward-level characteristics and the likelihood of a COVID-19 outbreak.

During period 2 and period 3, a total of 33 (11.1%) and 52 (17.4%) wards experienced an outbreak of COVID-19 infection. Factors associated with outbreak occurrence among wards assessed in period 1 were not included in further analyses as only 1% experienced outbreaks in this period.

For LTCFs assessed in period 2 (ancestral variant), multivariable analysis showed an increased risk for COVID-19 outbreak among those with vs without mechanical recirculation of air (adjusted odds ratio [aOR], 4.43; 95% CI, 1.26-15.61; P =.021).

For LTCFs assessed in period 3 (Alpha variant), factors associated with increased risk for COVID-19 outbreak included large vs small ward size (≥21 vs ≤10 beds; aOR, 8.10; 95% CI, 2.50-26.24; P <.001); providing psychogeriatric vs somatic care (aOR, 3.11; 95% CI, 1.04-9.33; P =.043); and fewer restrictions on staff movement (aOR, 4.49; 95% CI, 1.11-18.07; P =.035).

In addition, a higher number of COVID-19 diagnoses (>10 vs 0-3) among staff at LTCFs significantly increased outbreak risk (aOR, 12.50; 95% CI, 2.25-69.34; P =.004).

Limitations of this study include the lack of data on resident characteristics, potential confounding, and potentially limited generalizability to LTCFs in other countries.

According to the researchers, “[I]t is unclear whether cases among residents resulted from staff infections or whether cases among staff were the result of pre-existing cases among residents in LTCFs.” They also noted that “Staff and resident cohorting or the implementation of ward-bound or departmental teams could be potential strategies to limit transmission during outbreaks.”