Impact of long-term care facilities’ size on adherence to COVID-19’ infection prevention guidance

  1. Patrick Alexander Wachholz
  2. Ruth Caldeira de Melo
  3. Alessandro Ferrari Jacinto
  4. Paulo José Fortes Villas Boas

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Abstract

Abstract Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities’ managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities’ sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

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  1. Version published to 10.1590/1518-8345.5581.3516
  2. ScreenIT

    SciScore for 10.1101/2021.06.12.21258774: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethical approval was given by the institutional review board of the Botucatu Medical School, São Paulo State University (Unesp) for this cross-sectional study (CAAE 30577520.0.0000.0008, protocol no. 4.012.489), and all participants provided online informed consent.
    Consent: Ethical approval was given by the institutional review board of the Botucatu Medical School, São Paulo State University (Unesp) for this cross-sectional study (CAAE 30577520.0.0000.0008, protocol no. 4.012.489), and all participants provided online informed consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: We analyzed the data in SPSS version 20.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has limitations inherent in the cross-sectional design adopted and the potential for recall bias. Likewise, potential selection bias may have favored LTCFs with access to the internet and those with more complete teams, including workers dedicated to administrative tasks. The instrument used for data collection was tested in a pilot study,18 but it is not a validated instrument. Also, there are no established cutoff points to classify facilities by size, which may have influenced the findings. Nevertheless, all definitions adopted for the purpose of this study were defined a priori, and a large and nationally representative number of LTCFs was included. COVID-19 has been a pandemic, or a syndemic,27 of inequalities. Countries with successful responses, for instance, developed partnerships on multiple levels across government sectors, had timely triage and referral of suspected COVID-19 cases, and provided designated isolation facilities.28 The drama observed at the beginning of the pandemic, when COVID-19 deaths among LTCF residents were brutally high in some countries, was partly due to the lack of official guidelines and regulations for natural disasters and pandemics worldwide.29 Researchers found that only 57% of 182 countries could perform crucial activities to prevent, detect, and respond to an outbreak in the context of COVID-19.30 As previously stated, context matters.27 Coronavirus outbreaks will probably continue to occur worldwide for the following years...

    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.

    About SciScore

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  3. Version published to 10.1101/2021.06.12.21258774v1 on medRxiv