Canter Benjamin E, Ulyte Agne, McGarry Brian E, Barnett Michael L
Department of Occupational Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts.
RAND Europe, Cambridge, United Kingdom.
JAMA Health Forum. 2025 Jan 3;6(1):e245175. doi: 10.1001/jamahealthforum.2024.5175.
Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. A critical appraisal of these measures is essential to support SNFs in managing future infectious disease outbreaks.
To perform a scoping review of data and evidence on the use and effectiveness of preventive measures implemented from 2020 to 2024 to prevent COVID-19 infection in SNFs in the US.
Two analyses were performed. First, an analysis of the federal COVID-19 SNF Database was conducted to describe time trends in COVID-19 incidence, deaths, testing, vaccination, and treatment among SNF residents and staff, as well as shortages in staff and personal protective equipment (PPE). Then, a comprehensive literature search was conducted from May 2023 to April 2024 to identify high-quality evidence on the use and effectiveness of modifiable preventive measures used among SNF residents. Both nonpharmacologic (facility characteristics, PPE, cohorting, and isolation, visitation, staffing, testing) and pharmacologic (vaccination, treatment) measures were reviewed.
Nationwide data indicated early shortages of PPE, infrequent testing, and persistent staff shortages in SNFs. Other nonpharmacologic measures, such as visitor restrictions or ventilation modifications, were widely adopted but there were no available national data to quantify their effectiveness. These nonpharmacologic measures lacked high-quality studies to verify effectiveness. In contrast, the effectiveness of vaccination and antiviral treatment was shown in multiple studies. Evidence also showed associations between COVID-19 outcomes in residents and crowding, staff size, hours per residents and networks, and surveillance testing of residents and staff. Despite high initial uptake, up-to-date vaccination status was suboptimal in residents and staff from 2022 to 2024. Only a minority of infected residents received antiviral treatment.
This scoping review found that although many preventive measures were implemented in SNFs in the US throughout the COVID-19 pandemic, few were based on clear evidence of their effectiveness. Pharmacologic measures, such as vaccination and antiviral treatment, had more robust evidence supporting their efficacy than nonpharmacologic interventions. Using the scarce resources and staff of SNFs on measures of questionable effectiveness could distract from known effective ones such as vaccination and antiviral treatment. When possible, implementation efforts should be commensurate with the demonstrated effectiveness of available preventive measures.
在新冠疫情期间，熟练护理机构（SNFs）死亡率很高，这促使它们采取预防措施来应对病毒传播。对这些措施进行严格评估对于支持SNFs应对未来传染病爆发至关重要。
对2020年至2024年期间美国SNFs为预防新冠感染而实施的预防措施的使用情况和有效性的数据及证据进行范围审查。
进行了两项分析。首先，对联邦新冠SNF数据库进行分析，以描述SNF居民和工作人员中新冠发病率、死亡、检测、疫苗接种和治疗的时间趋势，以及工作人员和个人防护装备（PPE）的短缺情况。然后，在2023年5月至2024年4月期间进行全面的文献检索，以确定关于SNF居民中可改变的预防措施的使用情况和有效性的高质量证据。对非药物措施（设施特征、PPE、分组和隔离、探视、人员配备、检测）和药物措施（疫苗接种、治疗）都进行了审查。
全国数据表明，SNFs存在PPE早期短缺、检测不频繁以及持续的人员短缺问题。其他非药物措施，如访客限制或通风改造，被广泛采用，但没有可用的全国数据来量化其有效性。这些非药物措施缺乏高质量研究来验证其有效性。相比之下，多项研究表明了疫苗接种和抗病毒治疗的有效性。证据还显示了居民中新冠感染结果与拥挤程度、工作人员规模、每位居民的时长和网络以及居民和工作人员的监测检测之间的关联。尽管最初接种率很高，但2022年至2024年期间居民和工作人员的最新疫苗接种状况并不理想。只有少数感染居民接受了抗病毒治疗。
这项范围审查发现，尽管在整个新冠疫情期间美国的SNFs实施了许多预防措施，但很少有措施有明确的有效性证据。药物措施，如疫苗接种和抗病毒治疗，比非药物干预有更强有力的证据支持其疗效。将SNFs稀缺的资源和工作人员用于效果存疑的措施可能会分散对已知有效的措施（如疫苗接种和抗病毒治疗）的注意力。在可能的情况下，实施工作应与现有预防措施已证明的有效性相称。
