The highly contagious COVID-19 is a major threat especially to nursing homes, as elderly residents in there often have chronic conditions and disabilities making them vulnerable to infection. New research published in JAMA (Belmin et al. 2020) suggests that a COVID-19 outbreak can be avoided when nursing homes implement staff confinement with residents.
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At the height of COVID-19 pandemic in France in March-April 2020, staff members (n=794) at 17 nursing homes confined themselves to the facility with their residents (n=1,250). Data from this cohort study of nursing homes' staff self-confinement revealed a significantly lower incidence of COVID-19 among the residents and lower mortality, compared with overall national outcomes.
This retrospective study was conducted between 1 March and 11 May 2020. Of the 17 nursing homes in the cohort, 12 implemented a single course of self-confinement and five started a second course of self-confinement immediately after the first with renewed staff. There were no new admissions of residents during the self-confinement periods.
In this study, COVID-19 diagnoses were considered confirmed if results of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing were positive and considered possible if the test had not been performed or results were negative. Data was collected through telephone interviews with the directors of nursing homes.
The cohort study data was compared to incidence of COVID-19 reported by 9,513 nursing homes – where staff did not practice self-confinement – in a national survey conducted by French health authorities. The facilities surveyed together had 385,290 staff members and 695,060 residents.
Researchers reported these key findings:
- Only one nursing home with staff self-confinement (5.8%) had cases of COVID-19 among residents, compared with 4,599 facilities in the national survey (48.3%).
- Five residents (0.4%) in the nursing homes with staff who self-confined died of COVID-19, compared with 12,516 (1.8%) in the national survey.
- 12 staff members (1.6%) from the facilities with self-confinement had confirmed or possible COVID-19 infection, compared with 29,463 staff members (7.6%) in the national survey.
As noted by the researchers, almost all nursing homes with voluntary staff self-containment (except for 1) were able to keep their residents from being infected with COVID-19.
This cohort study suggests that implementation of nursing homes' staff self-confinement initiative was effective in protecting their facilities from an outbreak of COVID-19. However, screening for asymptomatic COVID-19 infections should be provided to staff members before they begin the confinement period with residents to ensure better outcomes, the researchers point out.
Source: JAMA
References:
Belmin J et al. (2020) Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents. JAMA Netw Open. 3(8):e2017533. doi: 10.1001/jamanetworkopen.2020.17533
