Abstract
Background: The SARS-CoV-2 pandemic has highlighted the risk of infection transmission in long-term care facilities (LTCF) and the vulnerability of resident populations. It is essential to understand the environmental spread of the virus and risk of indirect transmission to inform Infection Prevention and Control (IPC) measures in these settings. Methods: Upon notification of SARS-CoV-2 outbreaks, LTCF within a local authority in the South West of England were approached to take part in this pilot study. Investigators visited to swab common touch-points and elevated ‘non-touch’ surfaces and samples were analysed for presence of SARS-CoV-2 genetic material (RNA). Data were collected regarding LTCF infrastructure, staff behaviours, clinical and epidemiological risk factors for infection (staff and residents), and IPC measures. Criteria for success were: recruitment of three LTCF; detection of SARS-COV-2 RNA; variation in proportion of SARS-CoV-2 positive surfaces by sampling zone; potential to assess infection risk from SARS-CoV-2 positive surfaces. Results: Three LTCFs were recruited, ranging in size and resident demographics. Outbreaks lasted 63, 50 and 30 days with resident attack rates of 53%, 40% and 8%, respectively. The proportion of sample sites on which SARS-CoV-2 was detected was highest in rooms occupied by infected residents and varied elsewhere in the LTCF, with low levels in a facility implementing enhanced IPC measures. The heterogeneity of settings and difficulty obtaining data made it difficult to assess association between environmental contamination and infection. Elevated surfaces were more likely to test positive for SARS-CoV-2 RNA than common touch-points. Conclusions: SARS-CoV-2 RNA can be detected in a variety of LTCF outbreak settings. We identified variation in environmental spread which could be associated with implementation of IPC measures, though we were unable to assess the impact on infection risk. Sampling elevated surfaces could add to ongoing public health surveillance for SARS-CoV-2 and other airborne pathogens in LTCF.
Highlights
Long term care facilities (LTCF) are inadvertently ideal environments for the spread of pathogens. (Strausbaugh et al, 2003) Residents are often susceptible to infection or colonisation, and in frequent and close contact with staff who have links to the wider community
We identified variation in environmental spread which could be associated with implementation of Infection Prevention and Control (IPC) measures, though we were unable to assess the impact on infection risk
DISinFECT methods are detailed in the protocol which can be accessed online. (Kwiatkowska & Ready, 2021) long-term care facilities (LTCF) were eligible for inclusion if they provided residential care for older adults (>65 years), were within the boundaries of a selected local authority in the Public Health England (PHE) South West region, and experienced a COVID-19 outbreak, defined as two or more laboratory-confirmed cases among staff and/or residents within a 14-day period
Summary
Long term care facilities (LTCF) are inadvertently ideal environments for the spread of pathogens. (Strausbaugh et al, 2003) Residents are often susceptible to infection or colonisation, and in frequent and close contact with staff who have links to the wider community. If detected early enough transmission of pathogens within the LTCF can be curbed, (Inns et al, 2018) SARS-CoV2 infections are often asymptomatic or paucisymptomatic leading to large outbreaks. Swabbing touch-points and elevated surfaces (which airborne pathogens will settle on) could provide early warning of infection as well as providing insights into how the virus is transmitted, which can inform infection prevention and control (IPC) measures. COVID-19: Detecting Indirect Transmission in Facilities for Enhanced Care sTudy (COVID-19: DISinFECT) aims to investigate the role of indirect transmission of SARS-CoV-2 in LTCF and evaluate the potential for environmental surveillance to inform IPC measures. The SARS-CoV-2 pandemic has highlighted the risk of infection transmission in long-term care facilities (LTCF) and the vulnerability of resident populations. It is essential to understand the environmental spread of the virus and risk of indirect transmission to inform Infection Prevention and Control (IPC) measures in these settings.
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