Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
BMC Health Serv Res. 2022 Mar 15;22(1):339. doi: 10.1186/s12913-022-07481-w.
Infectious disease outbreaks are common in care homes, often with substantial impact on the rates of infection and mortality of the residents, who primarily are older people vulnerable to infections. There is growing evidence that organisational characteristics of staff and facility might play a role in infectious disease outbreaks however such evidence have not previously been systematically reviewed. Therefore, this systematic review aims to examine the impact of facility and staff characteristics on the risk of infectious disease outbreaks in care homes.
Five databases (MEDLINE, EMBASE, ProQuest, Web of Science, CINAHL) were searched. Studies considered for inclusion were of any design reporting on an outbreak of any infectious disease in one or more care homes providing care for primarily older people with original data on: facility size, facility location (urban/rural), facility design, use of temporary hired staff, staff compartmentalizing, residence of staff, and/or nursing aides hours per resident. Retrieved studies were screened, assessed for quality using CASP, and analysed employing a narrative synthesis.
Sixteen studies (8 cohort studies, 6 cross-sectional studies, 2 case-control) were included from the search which generated 10,424 unique records. COVID-19 was the most commonly reported cause of outbreak (n = 11). The other studies focused on influenza, respiratory and gastrointestinal outbreaks. Most studies reported on the impact of facility size (n = 11) followed by facility design (n = 4), use of temporary hired staff (n = 3), facility location (n = 2), staff compartmentalizing (n = 2), nurse aides hours (n = 2) and residence of staff (n = 1). Findings suggest that urban location and larger facility size may be associated with greater risks of an infectious disease outbreak. Additionally, the risk of a larger outbreak seems lower in larger facilities. Whilst staff compartmentalizing may be associated with lower risk of an outbreak, staff residing in highly infected areas may be associated with greater risk of outbreak. The influence of facility design, use of temporary staff, and nurse aides hours remains unclear.
This systematic review suggests that larger facilities have greater risks of infectious disease outbreaks, yet the risk of a larger outbreak seems lower in larger facilities. Due to lack of robust findings the impact of facility and staff characteristics on infectious disease outbreaks remain largely unknown.
CRD42020213585 .
传染病在养老院中很常见，通常会对感染率和居民死亡率产生重大影响，而居民主要是易感染的老年人。越来越多的证据表明，员工和设施的组织特征可能在传染病爆发中发挥作用，但这些证据以前并未进行系统审查。因此，本系统评价旨在研究设施和员工特征对养老院传染病爆发风险的影响。
检索了 5 个数据库（MEDLINE、EMBASE、ProQuest、Web of Science、CINAHL）。纳入的研究设计报告了一个或多个为主要老年人提供护理的养老院中任何传染病的爆发，具有以下原始数据：设施规模、设施位置（城市/农村）、设施设计、临时雇用员工的使用、员工分区、员工居住情况和/或护理人员每居民小时数。检索到的研究经过筛选、使用 CASP 进行质量评估，并采用叙述性综合进行分析。
从搜索中检索到 16 项研究（8 项队列研究、6 项横断面研究、2 项病例对照研究），共产生 10424 条独特记录。COVID-19 是报告最多的爆发原因（n=11）。其他研究侧重于流感、呼吸道和胃肠道爆发。大多数研究报告了设施规模的影响（n=11），其次是设施设计（n=4）、临时雇用员工的使用（n=3）、设施位置（n=2）、员工分区（n=2）、护理人员小时数（n=2）和员工居住情况（n=1）。研究结果表明，城市位置和较大的设施规模可能与传染病爆发的风险增加有关。此外，在较大的设施中，爆发的风险似乎较低。虽然员工分区可能与较低的爆发风险相关，但居住在高度感染地区的员工可能与更大的爆发风险相关。设施设计、临时员工使用和护理人员小时数的影响尚不清楚。
本系统评价表明，较大的设施传染病爆发的风险较高，但较大的设施爆发的风险似乎较低。由于缺乏强有力的发现，设施和员工特征对传染病爆发的影响在很大程度上仍然未知。
CRD42020213585。
