Groupe Hospitalier Sud Ile de France, Emergency Department, Melun, France.
Groupe Hospitalier Sud Ile de France, Internal Medicine Unit, Melun, France; Groupe Hospitalier Sud Ile de France, Infectious Diseases Unit, Melun, France.
Braz J Infect Dis. 2021 Jan-Feb;25(1):101039. doi: 10.1016/j.bjid.2020.11.004. Epub 2020 Dec 5.
The current coronavirus disease-2019 (COVID-19) pandemic caused 10,541 deaths among nursing home residents in France, by July 17th, 2020. This study reported the results of an urgent pre-hospital intervention in eight French nursing homes. A retrospective study was conducted from March 26th to May 7th, 2020, before and after the intervention of a task force which took action from April 9th to April 11th, 2020. The task force included nurses and specialists of the county general hospital. The intervention had four steps: i) daily notification of deaths; ii) audit by infectious diseases and hygiene specialists focused on nursing team reinforcing, tracking of suspected cases, patients' cohorting, review of preventive and protective measures, hydration, thromboembolism prevention; iii) intervention of an emergency team which urgently performed procedures suggested; iv) relay with a geriatric team. There were a total of 770 residents distributed in eight facilities with capacity varying from 53 to 145 residents. The number of deaths peaked at 139 in week 2 and the trough at 0 occurred in weeks 6-7. Comparison between periods (before vs after intervention) showed a significant decrease in number of new deaths (83/770; 11% vs 35/687; 5%, p = 0.0001) and new COVID-19 cases (348/770; 45% vs 123/422; 29%, p < 0.001). The urgent pre-hospital intervention by a multidisciplinary task force achieved mortality reduction during COVID-19 outbreak in nursing homes. Pre-hospital intervention is a valid alternative to hospitalization in case of hospital saturation.
截至 2020 年 7 月 17 日,法国的养老院中,有 10541 名居民死于当前的 2019 年冠状病毒病(COVID-19)大流行。本研究报告了在法国八家养老院中进行的一项紧急院前干预的结果。一项回顾性研究于 2020 年 3 月 26 日至 5 月 7 日进行,在此之前和之后,一个工作队于 2020 年 4 月 9 日至 4 月 11 日采取了行动。工作队包括县综合医院的护士和传染病与卫生专家。干预措施有四个步骤:i)每天通报死亡情况;ii)传染病和卫生专家进行审计,重点是加强护理团队,跟踪疑似病例,对患者进行分组,审查预防和保护措施,进行水化和预防血栓栓塞;iii)紧急行动小组的干预,紧急实施建议的程序;iv)与老年病学团队的交接。共有 770 名居民分布在 8 个设施中,每个设施的容量从 53 人到 145 人不等。死亡人数在第 2 周达到峰值 139 人,第 6-7 周达到最低点 0 人。在干预前后的时期(干预前与干预后)进行比较,新死亡人数(83/770;11%与 35/687;5%,p=0.0001)和新的 COVID-19 病例(348/770;45%与 123/422;29%,p<0.001)均显著减少。多学科工作队的紧急院前干预在 COVID-19 爆发期间降低了养老院的死亡率。在医院饱和的情况下,院前干预是住院治疗的有效替代方案。