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

Abstract

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.

Predictors of contracting COVID‐19 in nursing homes: Implications for clinical practice

“…Data collection involved a questionnaire (Appendix S1) devised by the researchers and based on existing guidelines of World Health Organization (WHO) (World Health Organization, 2021; World Health Organization. Regional Office for the Western Pacific, 2020), Centers for Disease Control and Prevention (CDC) (Centers for Disease Control and Prevention, 2021a) and a review of available articles (Dykgraaf et al, 2021; Thomas, 2021; Ueki et al, 2020). The questionnaire contained 32 questions, including 7 demographic and underlying diseases questions (including age, gender, educational level, chronic diseases, BMI, smoking, chronic diseases and taking medications), 16 questions about practice about infection prevention and control principles (including social distancing, using face masks, hand washing and sanitization and education for COVID‐19), 3 questions about probably predisposing factors of SARS‐CoV‐2 infection (including flu history and flu vaccine, and vitamin D intake), 7 questions about environmental and staff characteristics of nursing homes (including number of beds per room, air conditioning, place of taking meals, window in rooms, duration of staff shifts, ratio of nurse and healthcare workers to residents and presence of a glass shield between residents and visitors in visitors space) and 2 questions checking body temperature and fever; and preliminary signs and symptoms of residents getting infected by COVID‐19 in residents.…”

Cross-Sectional Analysis of Risk Factors for Outbreak of COVID-19 in Nursing Homes for Older Adults in the Community of Madrid

“…Other airborne (i.e., influenza) or intestinal (i.e., norovirus) viral infections are cause of outbreaks in nursing homes in NHOA; factors analyzed in this study as the number of susceptible subjects, seroprevalence, or the incidence of infections in the general population may also modulate the risk of those other infections [ 49 ].…”

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

“…Likewise, in residential centers for the elderly, the objective should be to achieve a minimum annual vaccination coverage against the influenza virus of over 75%, both in institutionalized persons and in the health and direct care personnel of the centers [49][50][51][52][53][54][55].…”