A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

  1. Kate Frazer
  2. Lachlan Mitchell
  3. Diarmuid Stokes
  4. Ella Lacey
  5. Eibhlin Crowley
  6. Cecily C Kelleher

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Abstract

The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors.

Setting

Long-term care facilities.

Participants

Residents, staff and visitors of facilities.

Primary and secondary outcome measures

Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted.

Results

The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents.

Conclusions

Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF.

PROSPERO registration number

CRD42020191569.

Article activity feed

  1. Version published to 10.1136/bmjopen-2020-047012
  2. ScreenIT

    SciScore for 10.1101/2020.10.29.20222182: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    EMBASE (via OVID), PubMed (via OVID), Cumulative Index to Nursing and Allied Health Literature (
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    CINAHL), Cochrane Database and Repository, and MedRXiv pre-published databases were searched.
    Cochrane Database
    suggested: None

    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:
    Limitations in the review process: A key strength of this review is that it addresses a knowledge gap and has collated evidence from a broad methodological base to report the measures to reduce transmission of COVID-19 in LTFC and reports characteristics of facilities. Due to the heterogeneity of studies, meta-analysis was not performed, while the descriptive nature of studies prevents identification of a causative relationship between measures and outcomes. Despite this, the systematic approach to this review has identified the scope of interventions implemented in LTFC to reduce COVID-19 transmission. Publication bias was minimized with inclusion of pre-published evidence, follow up contacts with authors for early reporting, and through the inclusion of observational study designs. Most studies reported are in English, we translated papers from German and Spanish as part of the assessment and review. Outbreak reports include convenience samples or smaller cohorts of residents in LTCF with limited data reported in brief reports and letters. However, real time reporting of outbreaks provides immediate evidence and shared understanding advocated by the Institute of Medicine.54 While the present review builds on a review by Salcher-Konrad, Jhass, Naci, Tan, El-Tawil, Comas-Herrera 55, a recent report from WHO,56 and from an Irish review report,57 data on the role of facilities in the transmission of COVID-19 are reported.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.29.20222182v1 on medRxiv