Marxe School of Public and International Affairs, Baruch College-City University of New York, New York, New York, USA.
J Am Geriatr Soc. 2021 Sep;69(9):2393-2403. doi: 10.1111/jgs.17302. Epub 2021 Jun 7.
US nursing homes are required to follow Centers for Disease Control guidance for COVID-19 transmission-based precautions (TBP) when admitting COVID-positive patients.
To assess how frequently nursing homes had shortages of personal protective equipment (PPE) or staffing in weeks when they admitted COVID-positive patients, which likely made it more difficult to follow TBP, and to compare facility characteristics by admissions practices.
Facility-level data from the Nursing Home COVID-19 Public File for the period between June 7, 2020 and March 7, 2021 was combined with additional data. The percentages of nursing homes that admitted COVID-positive patients and that had shortages when admitting were calculated for each week. Descriptive statistics and logistic regression models were used to examine the relationship between facility characteristics and the likelihood of admitting COVID-positive patients.
Facilities were categorized as having admitted COVID-positive patients in a week if one or more admissions requiring TBP were reported for that week. Facilities that reported having less than a 1-week supply of any type of PPE or being short any type of staff in a week were defined, respectively, as having a PPE shortage or staffing shortage in that week.
Over the 40-week study period, 39% of US nursing homes admitted COVID-positive patients in at least 1 week in which they were experiencing PPE or staffing shortages. Facilities that admitted COVID-positive patients with shortages generally had lower Centers for Medicare and Medicaid Services overall five-star ratings than other facilities. Only a small percentage of facilities that admitted COVID-positive patients while facing shortages were located in counties with severe shortages of PPE or staffing. In logistic regression models, shortages were not associated with COVID-positive admissions.
The widespread practice of admitting COVID-positive patients while facing shortages may have put nursing home residents and staff at heightened risk of COVID-19 infection.
美国养老院在接收 COVID-19 阳性患者时，必须遵循疾病控制中心关于基于传播预防措施（TBP）的指南。
评估养老院在接收 COVID-19 阳性患者的几周内，个人防护设备（PPE）或人员配备短缺的频率，这可能使遵循 TBP 变得更加困难，并按入院实践比较设施特征。
将 2020 年 6 月 7 日至 2021 年 3 月 7 日期间护理院 COVID-19 公共档案的设施级数据与其他数据相结合。为每周计算接收 COVID-19 阳性患者的养老院比例和接收时出现短缺的比例。使用描述性统计和逻辑回归模型检查设施特征与接收 COVID-19 阳性患者的可能性之间的关系。
如果报告了在该周内需要 TBP 的一次或多次入院，则将设施归类为在一周内接收了 COVID-19 阳性患者。如果在一周内报告 PPE 短缺或任何类型的人员短缺，则分别定义该周内存在 PPE 短缺或人员短缺。
在 40 周的研究期间，39%的美国养老院至少在一周内接收了 COVID-19 阳性患者，这些患者在 PPE 或人员配备方面存在短缺。在面临短缺的情况下接收 COVID-19 阳性患者的设施通常比其他设施的医疗保险和医疗补助服务中心总体五星评级较低。在面临短缺的情况下接收 COVID-19 阳性患者的设施中，只有一小部分位于 PPE 或人员配备严重短缺的县。在逻辑回归模型中，短缺与 COVID-19 入院无关。
在面临短缺的情况下普遍接收 COVID-19 阳性患者的做法可能使疗养院居民和工作人员面临 COVID-19 感染的风险增加。
