Blackburn Justin, Weaver Lindsay, Cohen Liza, Menachemi Nir, Rusyniak Daniel E, Unroe Kathleen T
Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health at Indianapolis, Indianapolis, IN, USA.
Indiana Department of Health, Indianapolis, IN, USA.
J Am Med Dir Assoc. 2021 Jan;22(1):204-208.e1. doi: 10.1016/j.jamda.2020.10.038. Epub 2020 Oct 28.
To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Cross-sectional study.
In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana.
Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000.
The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases.
We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity.
评估使用2019冠状病毒病（COVID-19）社区活动水平能否准确为设施工作人员进行严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染常规检测的策略提供依据。
横断面研究。
印第安纳州共有59930名疗养院工作人员接受了SARS-CoV-2感染的检测。
绘制受试者工作特征曲线及曲线下面积，以比较基于社区COVID-19活动水平（包括县阳性率和每10000人中的县病例数）识别设施内工作人员阳性病例的敏感性和特异性。
使用每10000人口中的县病例数或县阳性率来检测设施内任何受感染的工作人员，曲线下面积分别为0.648（95%置信区间0.601 - 0.696）和0.649（95%置信区间0.601 - 0.696）。在接受检测的工作人员中，28.0%是注册护理助理，但占所有检测呈阳性工作人员的36.9%。同样，执业护士占工作人员的1.4%，但占阳性病例的4.7%。
为了预测有任何阳性工作人员的疗养院，我们未能观察到有意义的社区COVID-19活动阈值。医疗保险和医疗补助服务中心在2020年8月发布的指南根据县阳性率设定了疗养院工作人员常规检测的最低频率。使用推荐的5%县阳性率要求每周检测可能会遗漏疗养院工作人员中的无症状感染。需要关于全体工作人员检测结果的更多数据，特别是随着即时检测等新的广泛策略的实施，以指导保护高危疗养院居民和工作人员的政策。如果目标是识别所有无症状感染SARS-CoV-2的疗养院工作人员，无论社区活动水平如何，可能都需要进行全面的重复检测。
