Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes.
Academic Medical Centers
Aged
Aged, 80 and over
COVID-19
/ epidemiology
Disease Outbreaks
Female
Homes for the Aged
/ organization & administration
Hospitalization
/ statistics & numerical data
Humans
Male
Michigan
/ epidemiology
Nursing Homes
/ organization & administration
Public Health Administration
Public-Private Sector Partnerships
/ organization & administration
SARS-CoV-2
United States
/ epidemiology
COVID-19
SARS-CoV-2
nursing home
outbreak
pandemic
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
10
07
2020
revised:
04
09
2020
accepted:
12
09
2020
pubmed:
10
10
2020
medline:
26
1
2021
entrez:
9
10
2020
Statut:
ppublish
Résumé
Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges. Outbreak investigation. Three NHs in southeast Michigan. All residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system. Upon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility-wide testing and the following intervention measures: cohorting of COVID-19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14-day outcomes. A total of 29 cases of COVID-19 were identified at three participating NHs. Nineteen cases of COVID-19 were identified through symptom-triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point-prevalence survey required hospitalization, and five were discharged home within 14 days. Proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.
Sections du résumé
BACKGROUND/OBJECTIVES
Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges.
DESIGN
Outbreak investigation.
SETTING
Three NHs in southeast Michigan.
PARTICIPANTS
All residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system.
METHODS
Upon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility-wide testing and the following intervention measures: cohorting of COVID-19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14-day outcomes.
RESULTS
A total of 29 cases of COVID-19 were identified at three participating NHs. Nineteen cases of COVID-19 were identified through symptom-triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point-prevalence survey required hospitalization, and five were discharged home within 14 days.
CONCLUSION
Proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.
Identifiants
pubmed: 33034039
doi: 10.1111/jgs.16869
pmc: PMC7675453
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-36Subventions
Organisme : NIA NIH HHS
ID : K24 AG050685
Pays : United States
Organisme : Michigan Institute for Clinical and Health Research
ID : UL1TR002240
Pays : International
Organisme : NIA NIH HHS
ID : P30 AG024824
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002240
Pays : United States
Organisme : Agency for Healthcare Research and Quality
ID : RO1HS25451
Pays : International
Organisme : AHRQ HHS
ID : R01 HS025451
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The American Geriatrics Society.
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