Factors influencing SARS-CoV-2 infection rate in Belgian nursing home residents during the first wave of COVID-19 pandemic

Abstract

In April 2020, Belgium experienced high numbers of fatal COVID-19 cases among nursing home (NH) residents. In response, a mass testing campaign was organised testing all NH residents and staff. We analysed data of Flemish NH to identify institutional factors associated with increased SARS-CoV-2 infection rates among NH residents. Cross-sectional study was conducted between April 8-May 15, 2020. Data collected included demographics, group category (i.e. staff or resident), symptom status and test result. We retrieved additional data: number of beds and staff, type of beds (level of dependency of residents) and ownership (public, private for profit/non-profit institutions). Risk factor analysis was performed using negative binomial regression.In total, 695 NHs were included, 282 (41%) had at least one resident tested positive. Higher infection rate among residents was associated with a higher fraction of RVT beds, generally occupied by more dependent residents (Incidence rate ratio (IRR): 1.97; 95%CI: 1.00-3.86) and higher staff's infection rate (IRR: 1.89; 95%CI: 1.68-2.12). No relationship was found between other investigated NH characteristics and infection rate among residents. Staff-resident interactions are key in SARS-CoV-2 transmission dynamics. Vaccination, regular staff testing, assessment of infection prevention and control strategies in all NHs are needed to face future SARS-CoV-2 epidemics in these settings.

COVID-19 Clusters in Belgian Nursing Homes: Impact of Facility Characteristics and Vaccination on Cluster Occurrence, Duration and Severity

“…A large-scale regional study in Belgium showed that higher infection rates among residents were linked to an increased infection rate among nursing home staff members and a higher fraction of beds for individuals who were heavily dependent. However, no association with the size or type of nursing home, mean age of residents/staff or the proportion of asymptomatic positive tested cases was found [ 25 ]. Other large-scale studies, conducted in the United States, Scotland and Canada did not find such associations [ 26 , 27 , 28 ].…”

“…Other large-scale studies, conducted in the United States, Scotland and Canada did not find such associations [ 26 , 27 , 28 ]. Since the provision and organizational structure of the nursing home setting can vary between countries and regions, comparing them with other geographical regions is challenging [ 1 , 25 ].…”

Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review

“…The individual factors that were most supported by the body of evidence with relation to COVID-19 outbreak include age [24,39,46,60,63,97,101,105,115], dependency level [22,46,54,58,63,72,101,105], frailty [24,58,115], sex (female) [45,56,91], and cognitive deterioration/dementia [105,107,115].…”

COVID-19 risks in private equity nursing homes in Hesse, Germany – a retrospective cohort study

“…Staff is an associated risk factor due to regular external contacts [ 12 , 13 ], which is moderated by the registered nurses’ ratio and number of staff members [ 5 , 14 , 15 ] and has been associated with fewer deaths by COVID-19 when there is a higher registered nurses’ ratio [ 14 , 16 ]. In Germany, a registered nurses’ ratio of 50% for qualified personnel is mandated; however, not all facilities are able to meet this requirement due to a shortage of skilled staff.…”