129 cases of COVID-19 have been linked to a long-term nursing facility in Washington. 23 people of these people died from the virus. COVID-19 had spread to a minimum of eight other long-term nursing facilities in the area following the
COVID-19 was transmitted between and within nursing facilities through inadequate practices, including:
- Symptomatic staff members continuing to work
- Care staff working in multiple facilities
- Not following aerosol and contact guidelines
- Insufficient personal protective equipment (PPE)
- Slow identification of COVID-19
Centres for Disease Control and Infection have identified the following measures to prevent transmission in long-term facilities:
Identify and exclude workers and visitors with COVID-19 symptoms. It is easier to prevent entry of COVID-19 into centres than manage the virus after it has been introduced. Strict restrictions on entry are a key way to achieve this. Any staff (especially agency workers or staff working at multiple facilities) should be risk-assessed for symptoms. Visitors should be restricted, and alternative arrangements should be put in place wherever possible. Video calls could replace visiting hours or phone calls can be arranged to contact family and friends. Ensure any devices such as smart phones are thoroughly decontaminated before and after use.
Clear and effective infection control processes. Staff should receive regular training on infection control procedures, and particularly respiratory hygiene. Facilities should ensure that key workers are aware of current research and clinical studies on the transmission of the virus, for example that COVID-19 is shed in the stool. Local guidelines should be adapted to ensure infection prevention, particularly in relation to respiratory processes and human waste management.
Adequate supply of PPE. Ensure a sufficient supply of PPE. If you are experiencing shortages, contact your local or national public health authority. Many centralised bodies are organising distribution channels for long-term facilities experiencing supply issues.
Regular testing and symptom identification. Residents and staff should be regularly tested for COVID-19 where possible. If this is not possible, they should regularly report symptoms (or lack of) to ensure that they are fit to work. Where staff are showing symptoms, follow your local or national health authority advice on exclusions and return-to-work protocols.
Further reading
McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:339-342. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e1
Adalja AA, Toner E, Inglesby TV. Priorities for the US Health Community Responding to COVID-19. JAMA. Published online March 03, 2020. doi:10.1001/jama.2020.3413
