COVID ‐19 Infection Prevention and Control Adherence in Long‐Term Care Facilities, Atlanta, Georgia

  1. Carson T. Telford
  2. Cyndra Bystrom
  3. Teresa Fox
  4. David P. Holland
  5. Sherry Wiggins‐Benn
  6. Anjum Mandani
  7. Meshell McCloud
  8. Sarita Shah

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Abstract

Recommendations for infection prevention and control (IPC) of COVID‐19 in long‐term care settings were developed based on limited understanding of COVID‐19 and should be evaluated to determine their efficacy in reducing transmission among high‐risk populations.

Design and Setting

Site visits to 24 long‐term care facilities (LTCFs) in Fulton County, Georgia, were conducted between June and July 2020 to assess adherence to current guidelines, provide real‐time feedback on potential weaknesses, and identify specific indicators whose implementation or lack thereof was associated with higher or lower prevalence of COVID‐19.

Participants

Twenty‐four LTCFs were visited, representing 2,580 LTCF residents, among whom 1,004 (39%) were infected with COVID‐19.

Measurements

Overall IPC adherence in LTCFs was analyzed for 33 key indicators across five categories: Hand Hygiene, Disinfection, Social Distancing, PPE, and Symptom Screening. Facilities were divided into Higher‐ and Lower‐prevalence groups based on cumulative COVID‐19 infection prevalence to determine differences in IPC implementation.

Results

IPC implementation was lowest in the Disinfection category (32%) and highest in the Symptom Screening category (74%). Significant differences in IPC implementation between the Higher‐ and Lower‐prevalence groups were observed in the Social Distancing category (Higher‐prevalence group 54% vs Lower‐prevalence group 74%, P < .01) and the PPE category (Higher‐prevalence group 41% vs Lower‐prevalence group 72%, P < .01).

Conclusion

LTCFs with lower COVID‐19 prevalence among residents had significantly greater implementation of IPC recommendations compared to those with higher COVID‐19 prevalence, suggesting the utility in adhering to current guidelines to reduce transmission in this vulnerable population.

Article activity feed

  1. Version published to 10.1111/jgs.17001
  2. ScreenIT

    SciScore for 10.1101/2020.08.13.20174466: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This activity was reviewed by the Georgia Department of Public Health Institutional Review Board and deemed exempt from IRB review as a public health surveillance activity in response to the COVID-19 emergency response.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of this analysis is that LTCFs were not selected randomly, but rather based on perceived importance by the FCBOH (prioritizing those with high proportions of resident infection) or per request from a LTCF. These data may not be representative of remaining Fulton County LTCFs that were not identified as “high-priority” or that did not request consultation. A second limitation is that some site visits were done over video-call rather than in person, potentially hindering our ability to observe IPC barriers. Future efforts are being coordinated to conduct in-person follow-up visits to LTCFs visited by video-call, and conduct site visits to remaining Fulton County LTCFs not represented in this analysis. The COVID-19 pandemic has highlighted the elevated risk of infectious disease outbreaks in LTCFs (1, 2, 9, 10). Efforts must be made to build, support, and monitor the capacity of LTCFs to protect the health and safety of residents through strict adherence to IPC recommendations. Guidelines for prevention and control of COVID-19 in LTCFs have been available since the early part of the epidemic (4-7). Although they were based on the best available science regarding COVID-19 transmission, there was little data to confirm they indeed protect LTCF residents. Our study provides direct support for these guidelines and suggests that widespread, effective implementation of the guidelines will in fact reduce transmission of COVID-19 in LTCFs.

    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.

    About SciScore

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  3. Version published to 10.1101/2020.08.13.20174466v1 on medRxiv