A comprehensive testing and infection-control collaboration helped reduce the rate of new COVID-19 positives in nursing homes from 35% to 18%, a new analysis from the Centers for Disease Control & Prevention (CDC) has determined.
In the early days of the COVID-19 pandemic, the Detroit Health Department proactively worked with academics, health care systems, local government officials, and the CDC to deploy testing and infection control support to skilled nursing facilities in the metropolitan region, the CDC described in its most recent Morbidity and Mortality Weekly Report (MMWR).
That initiative included “point prevalence surveys,” or blanket coronavirus tests that covered all staffers and residents regardless of their symptoms — or lack thereof.
The results were stark, if sadly typical of the virus’s impact in long-term care: Among 26 facilities in metropolitan Detroit, 44% of residents and staff members tested positive for the novel coronavirus between March 7 and May 8. Of that total, 24% were dead within three weeks of their first positive test, with 37% in the hospital.
But a team of researchers focused on the 12 facilities that health officials prioritized for a second round of point prevalence surveys, observing that the positive rate dropped from 35% to 18% between the first and second efforts.
Facilities achieved those gains by using the testing information to guide infection-control and “cohorting” strategies; the data also helped local officials to guide resources to the facilities that needed it most.
In addition, the on-the-ground infection prevention and control (IPC) assessments provided consultations on personal protective equipment (PPE) and how to effectively use existing floor plans to separate positive residents from those without the virus, among other key strategies.
“With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs,” the researchers concluded.
The facilities achieved those gains even while dealing with other stresses: Four of the 12, for instance, were unable to assign staffers exclusively to COVID units due to shortages.
The CDC analysis, while preliminary, appears to back up the decision in many states to perform baseline and repeat testing of nursing home residents and staff.
There have been pointed questions about the efficacy of mandatory routine testing of nursing home residents once outbreaks stabilize, especially given the invasive nature of the gold-standard polymerase chain reaction (PCR) test; because a given building’s infection-control strategy won’t change much after each individual’s status has been confirmed, some health leaders have argued that routine testing should focus instead on staffers, who could unwittingly bring the virus into a facility from the general community.
But with overall case counts surging in areas that were initially spared during the first wave of COVID-19 outbreaks, baseline and repeat testing has become vital at nursing homes in the South and Sun Belt — and the CDC research advised that the Detroit model consisted of “essential components of COVID-19 IPC strategies in SNFs experiencing COVID-19 outbreaks.”
“Repeated point prevalence surveys coupled with IPC support might have reduced SARS-CoV-2 transmission in SNFs in Detroit and have the potential to improve outcomes among SNF residents,” the CDC report concluded. “New cases continued to be identified during the second survey; however, reductions in 21-day hospitalization and mortality rates were observed throughout the implementation period.”