Bayesian evidence and epidemiological implications of environmental contamination from acute respiratory infection in long-term care facilities

Abstract

Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8-95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9-72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.

Health Literacy, Vaccine Confidence and Influenza Vaccination Uptake among Nursing Home Staff: A Cross-Sectional Study Conducted in Tuscany

“…One of the most vulnerable groups for severe disease and influenza-related complications is elderly people: globally, 67% of the deaths have occurred among people 65 years and older with large regional variation, from 36% in Sub-Saharan Africa to 86% in Europe [2]. In particular, in this age class, those living in nursing homes (NHs) suffer from higher likelihood of infection, getting sick and having comorbidities that increase vulnerability to poor outcome following infection [3][4][5][6].…”

Ventilation in Residential Care Environments

“…For decades, this vulnerable population has shared air, food, and healthcare in overcrowded settings ideal for the spread of infection. Each year, 2-3 million nursing home infections occur in the United States, resulting in 150,000 hospitalizations, 388,000 deaths, and up to $2 billion in additional healthcare costs (Diaz-Decaro et al 2018). In 2020, nursing home residents accounted for less than 0.5% of the U.S. population but almost 30% of its COVID-19 deaths.…”

Transmission and prevention of acute viral respiratory tract infections in hospitals

“…Examining high touch surfaces nearby, 2 of 10 showed environmental contamination with the same virus suggesting there was a significant risk of further spread. [6] Reliance on traditional epidemiological methods to track progress of a ward outbreak can be misleading. In one outbreak use of whole genome sequencing would have established a link between cases on opposite ends of a ward and avoided delay in infection control action and ward closure.…”