Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, P.O. Box 33, 6400 AA Heerlen, the Netherlands.
Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, P.O. Box 33, 6400 AA Heerlen, the Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
Int J Infect Dis. 2023 May;130:166-175. doi: 10.1016/j.ijid.2023.03.007. Epub 2023 Mar 9.
Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19. Yet, the reasons why certain LTCFs are affected more by outbreaks are poorly understood. This study aimed to identify the facility- and ward-level factors associated with SARS-CoV-2 outbreaks among LTCF residents.
We conducted a retrospective cohort study of multiple Dutch LTCFs (N = 60; with 298 wards providing care for ∼5600 residents) from September 2020 to June 2021. A dataset was constructed linking SARS-CoV-2 cases among LTCF residents to facility- and ward-level factors. Multilevel logistic regression analyses examined the associations between these factors and the likelihood of a SARS-CoV-2 outbreak among residents.
During periods of the Classic variant, the mechanical recirculation of air was associated with significantly increased odds of a SARS-CoV-2 outbreak. During periods of the Alpha variant, the factors associated with significantly increased odds included large ward size (≥21 beds), wards providing psychogeriatric care, fewer restrictions on staff movement between wards and facilities, and a greater number of cases among staff (>10 cases).
Policy and protocols on reducing resident density, staff movement, and mechanical recirculation of air in buildings are recommended to enhance outbreak preparedness in LTCFs. The implementation of low-threshold preventive measures among psychogeriatric residents is important because they appear as a particularly vulnerable group.
长期护理机构（LTCF）受 COVID-19 的影响不成比例。然而，某些 LTCF 受疫情影响更严重的原因尚不清楚。本研究旨在确定与 LTCF 居民中 SARS-CoV-2 爆发相关的设施和病房层面的因素。
我们对 2020 年 9 月至 2021 年 6 月期间荷兰多个 LTCF（N=60；有 298 个病房为约 5600 名居民提供护理）进行了回顾性队列研究。构建了一个数据集，将 LTCF 居民中的 SARS-CoV-2 病例与设施和病房层面的因素联系起来。多水平逻辑回归分析检查了这些因素与居民中 SARS-CoV-2 爆发的可能性之间的关联。
在经典变异时期，空气的机械再循环与 SARS-CoV-2 爆发的几率显著增加相关。在阿尔法变异时期，与几率显著增加相关的因素包括大病房规模（≥21 张床）、提供精神科护理的病房、对工作人员在病房和设施之间移动的限制较少，以及工作人员中的病例数较多（>10 例）。
建议制定减少居民密度、工作人员流动和建筑物内空气机械再循环的政策和方案，以增强 LTCF 的疫情应对准备。对精神科居民实施低门槛的预防措施很重要，因为他们是一个特别脆弱的群体。
