School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Infect Control Hosp Epidemiol. 2021 Oct;42(10):1181-1188. doi: 10.1017/ice.2020.1407. Epub 2021 Jan 5.
A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation.
Quasi-experimental, segmented regression analysis.
A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship.
A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type.
The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05).
Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.
加拿大卫生当局实施了一项多部门干预措施，旨在控制长期护理机构（LTCF）爆发期间严重急性呼吸系统冠状病毒 2 型（SARS-CoV-2）的传播。主要目的是在实施后 14 天评估干预措施的有效性。
准实验，分段回归分析。
一系列爆发措施分为 4 类：病例和接触管理、主动病例检测、严格的感染控制措施以及资源优先化和管理。
采用混合效应分段泊松回归模型拟合每 2 天计算一次的每个设施和病例类型（工作人员与居民）的 2019 年冠状病毒病（COVID-19）发病率。对于每个设施，将爆发时间段分为早期爆发期（干预后 14 天内）和干预后期间（干预后 14 天以上）。模型输出量化了这两个时期 COVID-19 发病率趋势和变化率。构建了一个二级模型来识别病例类型的效应修饰。
在早期爆发期间，COVID-19 发病率呈显著上升趋势（比率比 [RR]，1.07；95%置信区间 [CI]，1.03-1.11；P <.001），但在干预后期间逆转（RR，0.73；95%CI，0.67-0.80；P <.001）。在早期爆发期间，病例类型之间的平均趋势没有差异（P >.05）或干预后期间（P >.05）。然而，工作人员在干预后期间 COVID-19 的平均发病率下降幅度比居民大 70%（RR，0.30；95%CI，0.10-0.88；P <.05）。
我们的研究为该干预措施在减少长期护理机构中 COVID-19 传播的有效性提供了证据。该干预措施可以为其他司法管辖区所借鉴和利用，以保护长期护理机构中的弱势群体。
