Have infection control and prevention measures resulted in any adverse outcomes for care home and domiciliary care residents and staff?
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Abstract
What is a Rapid Review?
Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/question(s), the extent of the evidence base and type of analysis required for synthesis.
Background / Aim of Rapid Review
Care for older and vulnerable people must sustain core infection prevention and control (IPC) practices and remain vigilant for COVID-19 transmission to prevent virus spread and protect residents and healthcare professionals from severe infections, hospitalisations and death.
However, these measures could potentially lead to adverse outcomes such as decreased mental wellbeing in patients and staff. A recent publication by Public Health England examines the effectiveness of IPC practices for reducing COVID-19 transmission in care homes (Duval et al., 2021). We explore evidence relating to adverse outcomes from IPC practices to help inform policy recommendations and identify gaps within the literature where further research can be prioritised .
Key Findings
Extent of the evidence base
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15 studies were identified: 14 primary studies and one rapid review
Recency of the evidence base
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Of the primary studies, six were published in 2020 and eight were published in 2021
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The rapid review was published in 2021.
Summary of findings
This rapid review focuses on adverse outcomes resulting from increased IPC measures put in place during the COVID-19 pandemic. Whilst there is some evidence to show that there may be a link between IPC measures and adverse outcomes, causation cannot be assumed.
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During the COVID-19 restrictions, the cognition, mental wellbeing and behaviour of residents in care homes were negatively affected
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Increased IPC procedures during the COVID-19 pandemic increased stress and burden among care staff because of increased workload and dilemmas between adhering well to IPC procedures and providing the best care for the care recipients
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COVID-19 IPC procedures were not well developed at the beginning of the COVID-19 pandemic, but evidence from 2021 suggests that good adherence to IPC measures can enable visitations by family members and medical professionals into care homes
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Only one study investigating domiciliary care was found . Therefore, it is difficult to make conclusions related specifically to this care setting
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No published studies have reported on the costs or cost-effectiveness of IPC measures or have explored the cost implications of adverse outcomes associated with IPC measures
Best quality evidence
Only one study was deemed as high quality based on the quality appraisal checklist ranking. This was a mixed methods study design (Tulloch et al., 2021).
Policy Implications
Since March 2020, there have been many changes to government guidelines relating to procedures to keep the population safe from COVID-19 harm. Policies vary according to country, even within the UK. Important issues such as care home visitation policies have changed in such a way that care home staff have felt it difficult to keep up with the changes, which in itself increased the burden on those staff. The following implications were identified from this work:
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IPC policies should be clear, concise and tailored to care homes and domiciliary care settings
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Increased attention to workforce planning is needed to ensure adequate staffing and to reduce individual burden
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Restrictions (e.g. visitation) for care home residents needs to be balanced by additional psychological support
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Further research with robust methods in this area is urgently needed especially in the domiciliary care setting
Strength of Evidence
One limitation is the lack of high-quality evidence from the included studies . Confidence in the strength of evidence about adverse outcomes of COVID-19 IPC procedures was rated as ‘low’ overall. Whilst the majority of studies achieved a ‘moderate’ score based on the quality appraisal tools used, due to the nature of the methods used, the overall quality of evidence is low.
Article activity feed
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SciScore for 10.1101/2022.05.04.22274657: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:3.2 Limitations of the available evidence: One limitation is the lack of high-quality evidence from the included studies. Confidence in the strength of evidence about adverse outcomes of COVID-19 IPC procedures was rated as ‘low’ overall. Whilst the majority of studies were deemed to be of moderate quality according to the quality appraisal checklists used, due to …
SciScore for 10.1101/2022.05.04.22274657: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:3.2 Limitations of the available evidence: One limitation is the lack of high-quality evidence from the included studies. Confidence in the strength of evidence about adverse outcomes of COVID-19 IPC procedures was rated as ‘low’ overall. Whilst the majority of studies were deemed to be of moderate quality according to the quality appraisal checklists used, due to the nature of methods used and the standard of reporting, overall, the evidence was weak, and therefore quality was rated as ‘low’ overall. The key limitations of included studies are summarised in this report. However, due to the rapid nature of this review, quality appraisals were conducted (see Appendix 1), but no formal risk of bias was conducted. 3.3 Implications for policy and practice: Since March 2020, there have been many changes to government guidelines relating to procedures to keep the population safe from COVID-19 harm. Policies vary according to country, even within the UK. Important issues such as care home visitation policies have changed in such a way that care home staff have felt it difficult to keep up with the changes, which in itself increased the burden on those staff. The implications identified from this work are as follows: 3.4 Strengths and limitations of this Rapid Review: Strengths: Where previous rapid reviews focused on the effectiveness of IPC procedures for reducing COVID-19 transmission in care homes, this rapid review focused on adverse outcomes experienced by residents and staff f...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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