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Disclosures: The authors report no relevant financial disclosures.
August 11, 2020
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Universal testing contains COVID-19 outbreak in nursing home

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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A nursing home in Pennsylvania rapidly contained a COVID-19 outbreak by implementing a universal testing strategy for all residents and staff, according to study findings published in Clinical Infectious Diseases.

Daniel J. Escobar

“We chose to publish our experience managing a COVID-19 outbreak that occurred in a local nursing home because we think that our experience in controlling the outbreak could potentially help others that work in nursing homes or long-term care facilities if they are trying to develop action plans for managing a COVID-19 outbreak in their respective facilities,” Daniel J. Escobar, MD, an infectious diseases fellow at the University of Pennsylvania, told Healio.

According to Escobar, recently published data showed there have been more than 142,000 COVID-19 cases in nursing homes across the United States, and more than 38,000 COVID-19-related deaths. He said having a plan for management of COVID-19 outbreaks in long-term care facilities or nursing homes is essential to protect an older and more fragile population.

Escobar and colleagues described one such plan implemented at an eastern Pennsylvania nursing home with 84 residents, where universal policies were put in place following the identification of an outbreak.

On March 9, the nursing home implemented universal symptoms screening upon entering and denied access to anyone with symptoms. Additionally, it closed common areas, including the gym and cafeteria, on March 17 and closed the nursing home to new admissions on March 20. Between March 20 and April 16, 13 residents were tested for SARS-CoV-2 based on symptoms but all 13 tested negative. Between April 1 and April 8, four staff members tested positive after self-referral for testing based on symptoms, followed by a fifth employee on April 10. According to the study, this employee had been assigned 1:1 with a resident while asymptomatic, and the resident, although also asymptomatic, tested positive for SARS-CoV-2. Nursing home officials tested all residents in the same hall as the confirmed case, and all tested negative. However, according to the study, a resident in an adjacent hallway had a high temperature and ultimately tested positive for SARS-CoV-2.

Officials in the nursing home initiated universal, serial testing that uncovered two residents from the second unit who were now positive, confirming a widespread outbreak. By April 30, 212 asymptomatic staff were screened and 67 were tested due to symptoms. In total, 26 symptomatic and six asymptomatic staff members tested positive, leading to serial testing of the residents every 3 to 5 days. By April 20, 21 had tested positive. Serial screening continued, eventually identifying 27 cases among residents 14 of whom were asymptomatic at the time of identification.

As of July 1, there have been no new cases and the nursing home has maintained universal masking precautions for residents and staff, as well as the no-visitor policy.

“The key take-home message from our report is that long-term care facilities and nursing homes should consider adopting a universal and serial testing strategy for SARS-CoV-2, using a test that has a rapid turnaround time in order to quickly identify and isolate infected individuals,” Escobar said. “Nursing facilities should consider testing not only their residents but expand testing to all employees in the nursing home, not just those with direct patient contact, in order to isolate asymptomatic spreaders that could potentially bring the virus into the facility from the community.”

Escobar said the team’s success was likely due, in part, to direct access and affiliation with a medical facility hospital, which increased their access to testing and increased the number of available staff and experts qualified in infectious diseases, infection control and quality management.

“This might suggest that nursing homes should consider forming [a] long-term partnership with local hospitals to assist them with management of infectious disease outbreaks, not just with COVID-19, but with other infectious diseases in the future,” Escobar concluded.