Implementing a negative pressure isolation space within a skilled nursing facility to control SARS-CoV-2 transmission

Miller, Shawn W.; Mukherjee, Debanjan; Wilson, Joseph; Clements, Nicholas; Steiner, Cedric

doi:10.1016/j.ajic.2020.09.014

Cited by 40 publications

(57 citation statements)

References 15 publications

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“…Our findings that staff at site A have high pre-existing seroprevalence (>40%) prior to intensive monitoring suggests this facility experienced a prior outbreak and had a level of herd immunity that limited spread of the virus from two positive staff members [44]. It is possible that other control measures and policies instituted at the time of monitoring, such as negative pressure isolation space [45], surveillance and monitoring systems and quarantine of positive staff [39,[46][47][48], environmental cleaning [49,50], and others [51], additionally contributed to protection against outbreaks. It is notable that at both sites, seroprevalence reached a maximum of 40% during the study period, suggesting this might correspond to a level of herd immunity when coupled with other preventative measures.…”

Section: Discussionmentioning

confidence: 92%

Durable antibody responses in staff at two long-term care facilities, during and post SARS-CoV-2 outbreaks

Gallichotte

Nehring

Young

et al. 2021

Preprint

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SARS-CoV-2 has had a disproportionate impact on non-hospital healthcare settings such as long-term care facilities (LTCFs). The communal nature of these facilities, paired with the high-risk profile of residents, has resulted in thousands of infections and deaths and a high case fatality rate. To detect pre-symptomatic infections and identify infected workers, we performed weekly surveillance testing of staff at two LTCFs which revealed a large outbreak at one of the sites. We collected serum from staff members throughout the study and evaluated it for binding and neutralization to measure seroprevalence, seroconversion, and type and functionality of antibodies. At the site with very few incident infections, we detected that over 40% of the staff had preexisting SARS-CoV-2 neutralizing antibodies, suggesting prior exposure. At the outbreak site, we saw rapid seroconversion following infection. Neutralizing antibody levels were stable for many weeks following infection, suggesting a durable, long-lived response. Receptor-binding domain antibodies and neutralizing antibodies were strongly correlated. The site with high seroprevalence among staff had two unique introductions of SARS-CoV-2 into the facility through seronegative infected staff during the period of study but these did not result in workplace spread or outbreaks. Together our results reveal that high seroprevalence rate among staff can contribute to herd immunity within a workplace and protect against subsequent infection and spread within a facility.

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Section: Discussionmentioning

confidence: 92%

Durable antibody responses in staff at two long-term care facilities, during and post SARS-CoV-2 outbreaks

Gallichotte

Nehring

Young

et al. 2021

Preprint

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show abstract

“…Several studies have demonstrated how large rooms or a group of rooms in a medical facility can rapidly be converted into isolation facilities by changing air flows [86][87][88][89][90][91]. In a skilled nursing facility in Lancaster, Pennsylvania, USA, an existing HVAC system was modified to minimise disease transmission between residents and staff and maintained an average pressure differential of −2.3 Pa (SD = 0.12 Pa) with the external hallway, and no transmission of SARS-CoV-2 between residents isolated to the space or transmission to the staff or other residents occurred [92].…”

Section: Increasing the Use Of Medical Or Surgical Masks And Hand Hygiene To Reduce The Transmission Of Respiratory Virusesmentioning

confidence: 99%

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

Thomas

2021

Geriatrics

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The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

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“…21 Diamond (2020). The first facility in Pennsylvania to accept COVID patients was much larger than average and had just built a negative pressure wing (Miller, et al 2020).…”

Section: Ivb Employees Of Duke Health and Meat Processors Before And After Prevention Protocolsmentioning

confidence: 99%

The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19

Mulligan¹

2021

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provided time series data on infections among healthcare workers. The views expressed herein are those of the author and do not necessarily reflect the views of the National Bureau of Economic Research.NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

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Implementing a negative pressure isolation space within a skilled nursing facility to control SARS-CoV-2 transmission

Cited by 40 publications

References 15 publications

Durable antibody responses in staff at two long-term care facilities, during and post SARS-CoV-2 outbreaks

Durable antibody responses in staff at two long-term care facilities, during and post SARS-CoV-2 outbreaks

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19

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