Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. Methods: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann–Whitney U test, Kruskal–Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and “being a COVID-19 case” as the dependent variable. Results: Median cumulative incidence was not significantly associated with any of the variables, except for geographical region (p = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45.2% median cumulative incidence). Conclusions: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them.
Highlights
The median cumulative incidence of outbreaks of COVID-19 in nursing homes was 4.8% overall; in nursing homes participating in the survey was 2.9%, and 17% among homes not participating, but this difference was not statistically significant
Information on the individual characteristics of the residents of nursing homes was not available for this analysis; the aim of the present study was to assess the effect of non-clinical factors associated with COVID-19 cases, not to investigate other resident outcomes, which could have been affected by other risk factors, alongside the reliability of data collected during the initial emergency phase
The COVID-19 outbreak in this region confirmed the vulnerability of nursing homes in the face of the COVID-19 pandemic
Summary
The coronavirus disease 2019 (COVID-19) pandemic, caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), has had a marked impact on every sector of society, with long-term care facilities for the elderly bearing a disproportionate amount of the disease burden and mortality [1]. Long-term care facilities for the elderly encompass, in different countries and healthcare systems, a broad range of institution types, with or without the delivery of skilled nursing care. The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann–Whitney U test, Kruskal–Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and “being a COVID-19 case” as the dependent variable
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