Mobile PCR-based surveillance for SARS-CoV-2 to reduce visiting restrictions in nursing homes during the COVID-19 pandemic: a pilot study

Abstract

Purpose Residents in nursing homes for the elderly (NH) are at high risk for death from COVID-19. We investigated whether repeated non-mandatory RT-PCR SARS-CoV-2 surveillance of NH staff and visitors reduces COVID-19 incidence rates in NH residents and allows to reduce visiting restrictions. Methods This pilot study at the beginning of the COVID-19 pandemic compared a surveillance approach of regular, twice-weekly voluntary PCR testing of health-care workers (HCW) and visitors in interventional NH (INH) with a setting without regular testing in control NH (CNH). Residents were not tested routinely within this study. Testing was performed in a mobile testing site with same-day result reporting. SARS-CoV-2 incidence among residents in both INH and CNH was the primary endpoint; secondary endpoints being SARS-CoV-2 infection among visitors and HCW in INH. Results Two INH and two CNH participated between October and December, 2020. At INH1, 787 tests of HCW and 350 tests of visitors were performed, accounting for 18.1% (n = 1930) of visits. At INH2, 78 tests of HCW and 372 tests of visitors were done, i.e., 30.5% (n = 1220) of visits. At the two INH 23 HCW and three visitors tested positive for SARS-CoV-2. COVID-19 outbreaks occurred among residents in INH1 (identified through study testing) and in CNH1. Utilization of voluntary testing was low. Conclusion In a real-world setting without available rapid testing, voluntary RT-PCR SARS-CoV-2 testing of HCW and visitors does not prevent COVID-19 outbreaks in NH. Complete, non-selective testing for these groups should be instituted before visiting restrictions can be reduced. Trial registration The study has been registered at ClinicalTrials.gov with the identifier: NCT04933981.

Learning from the covid-19 outbreaks in long-term care facilities: a systematic review

“…Green et al [ 39 ] lack explicit confounding factor variables, hindering intervention impact understanding. Zimmerman et al [ 40 ] do not detail the methods used to measure exposure, the instruments employed, or the steps taken to ensure the accuracy and consistency of measurements.. One of the quasi-experimental studies [ 41 ] did not raise concerns; The second quasi-experimental study [ 42 ] exhibits limitations as it lacks consistent and comprehensive information regarding whether participants, in distinct comparison groups received comparable treatment or care, apart from the specified exposure or intervention being investigated. It is also unclear whether the follow-up was complete ( Supplementary material ).…”

“…Due to the low statistical power of this study, we did not observe any statistically significant results Orlando 2022 [ 38 ] Italy Case–control To understand which organizational –structural characteristics of nursing homes and the preventative measures adopted in response to the pandemic are associated with the risk of a COVID-19 outbreak March–December 2020 100 Cases : 20 LTCF reported an outbreak COVID-19 Control : 80 LTCF without COVID-19 Cases: 20 LTCF reported an outbreak COVID-19 Control: 80 LTCF without COVID-19 NR NR The article does not provide any local or national statistics There was evidence of a higher risk of COVID-19 in larger facilities and when new patients were admitted during the pandemic. All other structural–organisational characteristics and preventative measures were not associated with an outbreak Stemler et al, 2022 [ 42 ] Germany Quasi-experimental study To investigated whether repeated non-mandatory RT-PCR SARS-CoV-2 surveillance of Nursing Homes (NH) staff and visitors reduces COVID-19 incidence rates in NH residents and allows to reduce visiting restriction From early October 2020 to mid-December 2020 at maximum 4 (2 Interventional Nursing Homes (INH); 2 control Nursing Homes (CNH)) Cases: 2 INH 260 residents 335 Health Care Workers (HCW) (865 tests) 3150 visitors (722 tests) Control : 2 CNH 261 residents 425 HCW 3649 visitors Cases : 2 INH Staff – 23 Visitors – 3 Control : 2CNH NR Cases : Residents –23 (8.8%) Control : Residents – 4 (1.5%) NR At the beginning of the study period, the local incidence of SARS-CoV-2 in the City of Cologne was 99.4 infections/100,000 inhabitants/week, then rose to a maximum of 227.9 infections/100,000 inhabitants/week on October 30th, subsequently decreased to a lowest level of 129.3 infections/100,000 inhabitants/week on November 27th, and then rose again to 161.8 infections/100.000 inhabitants/week by December 18th, 2020 In a real-world setting without available rapid testing, voluntary RT-PCR SARS-CoV-2 testing of HCW and visitors does not prevent COVID-19 outbreaks in NH. Complete, non-selective testing for these groups s...…”

“…Regarding mealtimes, the patients usually ate their food in the lounges; however, they were now required to eat in their respective rooms during the pandemic. Further, the patients’ families were restricted from meeting the patients, except in emergency situations Orlando 2022 [ 38 ] A binary logistic regression model evaluated the association between potential risk factors with the probability of reporting at least two positive cases among residents Strategic > 15 beds (vs < 15 beds) 5.37 (1.58 to 22.8), p < 0.05, for COVID-19 outbreak Presence of multiple rooms The proportion of single rooms Separate entrances Presence of isolation environment Active surveillance of staff Presence of written operational procedure for the management of cases External cleaning company Presence of a written operational procedure for new admissions Access by external suppliers Opened to visitors post-first lockdown Tactic Frequency of shifts staff Presence of a grey area for healthcare and non-healthcare staff Dressing rooms for staff Trained staff on procedures to contain COVID-19 Trained residents on procedures to contain COVID-19 Operational Use of personal protective equipment Active surveillance for guests Stemler et al, 2022 [ 42 ] We evaluated the occurrence of symptomatic SARSCoV-2 incidence among residents in both INH and CNH as the primary endpoint (with an outbreak defined as the occurrence of ≥ 1 SARS-CoV-2-infected resident in a timely and situational context). Qualitative data were summarized by absolute and relative (%) frequency and quantitative data by a median and interquartile range (IQR) Differences in categorical frequency distributions were only tentatively evaluated using the Chi-square test since the assumption of independent observations is untenable, and more adequate methods require more data Strategic Regular and voluntary RT-PCR SARS-CoV-2 testing of HCWs and visitors Tactic Operational ...…”

Clinical evaluation of the Diagnostic Analyzer for Selective Hybridization (DASH): A point-of-care PCR test for rapid detection of SARS-CoV-2 infection

“…Thus, DASH test characteristics are less certain for those at greatest risk for severe COVID-19 or among certain special populations. Although, other PCR-based SARS-CoV-2 testing technologies have generally performed well across many different high-risk patient groups [ 46 – 51 ]. Finally, we obtained anterior nasal swabs for this study and did not do a comparison of nasopharyngeal swabs.…”

Mobile SARS‑CoV‑2 screening facilities for rapid deployment and university‐based diagnostic laboratory

“…Various testing modalities were used worldwide to contain the pandemic. Drive‐through testing centers, home visiting testing, and walk‐through centers represent the most common approaches, with some groups also providing mobile testing facilities [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Since the beginning of the SARS‐CoV‐2 pandemic, polymerase chain reaction (PCR) tests have routinely been used to confirm an acute infection and are still considered the gold standard for diagnostic tests.…”