Home Outbreaks Research Articles

Listening and learning: a qualitative study of Scottish care home staff experiences of managing COVID-19 between March 2020-August 2022

BackgroundThe serious outcomes of outbreaks of COVID-19 in care homes have been described internationally. The experiences of professionals working through outbreaks has received less attention, missing opportunities to acknowledge and learn lessons. Our aim was to explore the experiences of care home staff in Scotland of managing COVID-19 within their homes to help inform understanding and future practice.MethodsFrom April to August 2022, 34 individual semi-structured interviews were conducted with care home staff working in homes which experienced an outbreak(s) of COVID-19. Reflexive thematic methods were used to analyse verbatim deidentified transcripts.FindingsThere was no singular experience of COVID-19 outbreaks within care homes. We identified four broad groupings of homes with outbreaks (significant outbreaks, managed outbreaks, outbreaks in remote/rural homes & outbreaks in homes supporting younger adults), with overlaps in timing and severity and variation in the support received and impact. The national response to the COVID-19 pandemic resulted in fundamental change to care home relationships. Staff responded by adaptation in uncertainty. However, they were challenged by emerging inequalities influencing residents’ care. There were tensions between staff experience and evolving external approaches to regulation and oversight. All this change resulted in psychological impacts on staff. However, there was also widespread evidence of compassionate leadership and teamwork in their responses. Effective sources of support were underpinned by respectful relationships and continuity, tailored to individual contexts.ConclusionsThe lived experiences of care home staff during the COVID-19 pandemic provide valuable insights applicable beyond the pandemic context. This includes: recognition of the specialism, complexity and diversity of care home practice; the value afforded by embedding genuine representation and involvement in planning, policy-making and research; the need for individualising to people in their contexts and the value of fostering respectful relationships across professional groups to support residents.

The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review

BackgroundInfectious 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.MethodsFive 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.ResultsSixteen 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.ConclusionsThis 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.ProsperoCRD42020213585.

What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016\u20132018

BackgroundOutbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings.MethodsWe analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression.ResultsFrom the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01–1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60–0.91), compared to outbreaks caused by other viral pathogens.ConclusionsThese results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.

Statistical Analysis of Fire Outbreaks in Homes and Public Buildings in Nigeria: A Case Study of Lagos State

The fire has often been described as the greatest servant but the worst master difficult to control when it turns into a conflagration, burning and destroying everything in its path. In the rage of its fury, it has no respect for anyone, not even the monarchy. Buildings as infrastructure along with people’s lives need protection against fire outbreaks. Data on fatal fire outbreaks in Lagos metropolis from2009 to 2014 were obtained from various rescue agencies in the state. Interviews were conducted alongside the structured questionnaires administered to a good number of citizens of the state. A statistical tool adopted in this research is the statistical package for social sciences (SPSS). The analysis made using the information from the agencies consulted shows that most fatal fires in homes often start in a bed, sofa, other loose fittings or clothing. The homes where fatal fires occur are rarely protected by smoke detectors. Fire death rates are higher for males than females and are also higher for the elderly than for younger people. Most home fires attended by the firefighters are quite small. In blocks of flats, the most common cause is a cooking appliance being left on. Arson is also a common cause in blocks of flats, though arson is most often observed in stairwells and cellars and is rarely directed at living accommodation. Arson is the most common cause of fires in public buildings. Several remedies were specified to alleviate fire outbreaks in homes and public buildings.

Design and Implementation of a Compact Home Security System

This paper presents the design and implementation of a compact home security system. The use of security systems in today’s home where safety is an important issue cannot be over emphasized. The high crime rates and domestic hazards has brought up the need to take proper measures to prevent intrusions and hazards. It is in this regard that the design and implementation of a compact home security system based on the Global System for Mobile communication (GSM) comes in. Previous designs have used finger print protection, password protection, speech recognition, sensors with buzzer alarms, SMS and e-mail alerts but the designs were with so much complexities as well as at a cost disadvantage. The system presented here is of a minimal cost and simple design, it consists of one motion sensor, one temperature sensor, and one gas sensor. The system was designed using the ATMEGA 8 microcontroller which controls the sending of SMS to the authorized number. The motion sensor (infrared) detects the movement of people entering the house and when there is a detection of an intruder the owner is notified through an SMS. The temperature sensor in this system also initiates an SMS to the owner when the temperature exceeds a particular value. The gas sensor also works in similar manner when it detects smoke and gas thereby sending SMS alert to the owner of the house. The respective sensors detected the compromise in each situation and sent the corresponding SMS to the user. This device therefore helps to prevent intruders, accidents arising from harmful gases and fire outbreaks in homes, offices and industries.

Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

We assess the effect of key care quality indicators on viral gastroenteritis outbreaks and control in care homes using mandatory inspection data collected by a non-departmental public body. Outbreak occurrence was associated with care home size but not with overall quality or individual environmental standards. Care home size, hygiene and infection control standard scores were inversely associated with attack rate in residents, whereas delayed reporting to the local public health agency was associated with higher attack rates.

P20.06 Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

P20.06 Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes

Influenza outbreaks in elderly care institutions

Influenza outbreaks in elderly care homes pose a serious threat to residents. Several recent outbreaks in British care homes have been associated with high levels of morbidity and mortality. In this article, Jonathan Nguyen-Van-Tam reviews the subject and discusses the prevention and control of influenza in care homes.

Epidemiologic features of domestically contracted shigellosis in a Tokyo Metropolitan Hospital

Sixty-nine Japanese patients infected with shigellosis domestically were admitted to a hospital in eastern Tokyo from January 1988 to December 1995. According to a review of their charts 92% of these patients lived in Tokyo, and 88% contracted the disease in Tokyo. Sixty-eight percent and 29% of them were infected withShigella sonnei and S.flexneri, respectively. Of the twenty outbreaks identified, the majority occurred in homes, with as many as 50% of the patients under 10 years old infected withS. sonnei associated with the outbreaks in homes. It took a mean of 2.5 days to make a correct diagnosis for the symptomatic patients who initially contacted our hospital, in contrast to a mean of 5.6 days for those who initially visited other hospitals. Our results indicate that domestic shigellosis is a significant medical problem in Tokyo.

Risks of Practices, Procedures and Processes that Lead to Outbreaks of Foodborne Diseases

Factors that contributed to outbreaks of foodborne diseases reported in the U.S. from 1977–1982 are identified and classified by disease and place where implicated foods were mishandled. Data for these years are tabulated and combined with data from the years 1961–1976. Inadequate cooling - either leaving foods at room or warm outside temperatures or storing them in large containers while being refrigerated - was associated with most of the outbreaks. Ranking of all factors has changed little over four periods of review, but during the last period numerous outbreaks primarily due to ingestion of raw clams and raw oysters caused an increase in the factors: contaminated raw foods and obtaining foods from unsafe sources. This has been primarily due to raw clam-, oyster- and milk-associated outbreaks. The three most frequently identified factors that contributed to salmonellosis were improper cooling, contaminated raw products, and inadequate heating; to staphylococcal food poisoning were colonized persons handling cooked foods, lapse of 12 or more hours between preparing and eating, and improper cooling; to botulism were inadequate heat processing, improper fermentations, improper room temperature holding; to C. perfringens enteritis were improper cooling, lapse of 12 or more hours between preparing and eating, and inadequate reheating (followed closely by improper hot holding); to shigellosis were colonized persons handling implicated foods, improper cooling, and lapse of 12 or more hours between preparing and eating; to V. parahaemolyticus gastroenteritis were contaminated raw ingredients, improper cooling, and cross contamination; to typhoid fever were colonized persons handling implicated foods, lapse of 12 or more hours between preparing and eating, and several time-temperature factors tied for third; to B. cereus gastroenteritis were improper cooling, lapse of 12 or more hours between preparing and eating, and improper hot holding. The principal factors associated with outbreaks stemming from foods prepared in foodservice establishments were improper cooling, lapse of 12 or more hours between preparing and eating, colonized persons handling implicated foods, inadequate reheating and improper hot holding. Important factors that contributed to outbreaks in homes were contaminated raw foods, inadequate cooking, unsafe source, improper cooling, and lapse of 12 or more hours between preparing and eating. Major contributing factors associated with operations in food processing plants were inadequate heat processing, contaminated raw ingredient, improper cooling, colonized persons handling implicated foods, improper cleaning of equipment, and improper fermentation. Those factors cited above for each category are the vital few items to stress in food safety programs. The many other items that are a part of food protection programs are of lesser importance or trivial.

Policies and outcomes for control of influenza among the elderly in the USA.

For about 20 years official recommendations have been made to provide influenza vaccine to elderly persons in the USA because they are high risk of complications if infected during epidemics. Residents of homes for the aged (Nursing Homes) are of particular concern and we have studied this subgroup in greater detail than before. A prospectively organized surveillance programme of about 7000 residents of more than 65 homes in several states indicated that vaccination rates varied from about 9 to 98%, with the average about 60%. Biases in vaccinating residents according to age and medical condition were not detected. Vaccine use was greatest when the policy of the homes was to administer vaccine without requesting consent of relatives. In separate studies of influenza A(H3N2) outbreaks in homes for the elderly during 1982/83, influenza vaccine was found to reduce influenza-associated mortality by about 75% although febrile respiratory illness rates were reduced less than 50%. The frequency of outbreaks was lowest in homes having fewest residents, and highest vaccination rates. Professional Educational Programmes are no being developed to assist homes for the elderly to improve the organization of their influenza vaccination activities in an attempt to further reduce influenza mortality.