Implementation of a national testing policy in Dutch nursing homes during SARS-CoV-2 outbreaks.

BACKGROUND: To evaluate how a national policy of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) regardless of symptoms was implemented during outbreaks in Dutch nursing homes in the second wave of the pandemic and to explore barriers and facilitators to serial testing. METHODS: We conducted a mixed-method study of nursing homes in the Netherlands with a SARS-CoV-2 outbreak after 15 September 2020. Direct care staff and management from 355 healthcare organizations were invited to participate in a digital survey. A total of 74 out of 355 (20.9%) healthcare organizations participated and provided information about 117 nursing homes. We conducted 26 in-depth interviews on the outbreak and the testing strategy used. We also conducted four focus group meetings involving managers, physicians, nurses, and certified health assistants. Recordings were transcribed and data were thematically analyzed. RESULTS: One hundred and four nursing homes (89%) tested residents regardless of their symptoms during the outbreak, and 85 nursing homes (73%) tested the staff regardless of their symptoms. However, interviews showed testing was sometimes implemented during later stages of the outbreak and was not always followed up with serial testing. Barriers to serial testing regardless of symptoms were lack of knowledge of local leaders with decisional making authority, lack of a cohort ward or skilled staff, and insufficient collaboration with laboratories or local public health services. Important facilitators to serial testing were staff willingness to undergo testing and the availability of polymerase chain reaction (PCR) tests. CONCLUSIONS: Serial testing regardless of symptoms was only partially implemented. The response rate of 21% of nursing home organizations gives a risk of selection bias. Barriers to testing need to be addressed. A national implementation policy that promotes collaboration between public health services and nursing homes and educates management and care staff is necessary.

The Impact of COVID-19 from the Perspectives of Dutch District Nurses: A Mixed-Methods Study.

Little is known about how COVID-19 affects older patients living at home or how it affects district nursing teams providing care to these patients. This study aims to (1) explore, from the perspectives of Dutch district nurses, COVID-19's impact on patients receiving district nursing care, district nursing teams, and their organisations during the first outbreak in March 2020 as well as one year later; and (2) identify the needs of district nurses regarding future outbreaks. A mixed-methods, two-phase, sequential exploratory design was followed. In total, 36 district nurses were interviewed during the first outbreak (March 2020), of which 18 participated in the follow-up questionnaire in April 2021. Thirteen themes emerged, which showed that the COVID pandemic has substantially impacted patient care and district nursing teams. During the first outbreak, nurses played a crucial role in organising care differently and worked under high pressure, leading to exhaustion, tiredness, and psychosocial problems, including fear of infection. A year later, nurses were better prepared to provide COVID care, but problems regarding work pressure and mental complaints remained. The identified needs focus on a sustainable implementation of leadership roles for district nurses. At the organisational and national levels, more support and appreciation are needed in terms of trust and appropriate policies.

Patient experience and satisfaction with admission to an acute geriatric community hospital in the Netherlands: a mixed method study: Managing Community Care

PurposeThe acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.Design/methodology/approachThis is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.FindingsA total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received;there were also suggestions for improvement.Research limitations/implicationsLimitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.Originality/valueThis is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.

Symptom- and Prevention-Based Testing of COVID-19 in Nursing Home Residents: A Retrospective Cohort Study.

Nursing homes (NH) residents with COVID-19 can either be tested because of presence of core symptoms (S-based) or because of transmission prevention (TP-based). The investigated study sample included all NH residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 (n = 380). Clinical symptoms, temperature, and oxygen saturation were extracted from medical records, 7 days before to 14 days after testing. COVID-19 was confirmed in 81 (21%) residents; 36 (44%) S-based and 45 (56%) TP-based: 45. Cycle threshold (CT) values did not differ between the groups. In the 7 days prior to the test falling (32%), somnolence (25%) and fatigue (21%) occurred in both groups. Two days before the test, we observed a stronger decrease in oxygen saturation and an increase in temperature for the S-based group compared to the T-based group that remained up to 10 days after testing. Residents within the S-based group were 2.5 times more likely to increased mortality within 30 days than residents in the TP-based group (HR, 2.56; 95% 1.3-5.2). Although, 73% of the T-based group did eventually develop core symptoms. Thus, attention to falling and daily measures of temperature and oxygen saturation can contribute to earlier detection.

Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam.

OBJECTIVE: Governmental measures to protect older adults from COVID-19 are hypothesized to cause anxiety and depression. Previous studies are heterogeneous and showed small effects. This study aims to assess depressive and anxiety symptoms and perceived mastery just after the first wave of the COVID-19 pandemic compared to previous years in community-dwelling older adults and to identify potential risk groups according to the comprehensive geriatric assessment framework. METHODS: Data were used from 1068 Dutch older adults (aged 55-93 at baseline in 2011-2013) participating in the Longitudinal Aging Study Amsterdam, including 4 follow-ups spanning 9 years. Depressive symptoms, anxiety symptoms and feelings of mastery were assessed with the short Center for Epidemiologic Studies Depression scale (CES-D-10), the Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) and the Pearlin Mastery Scale. Linear mixed regression was used to compare outcomes in June-August 2020 to previous years and to examine predictors to identify risk groups. RESULTS: Slight increases in CES-D-10 (1.37, 95% Confidence interval [CI] 1.12;1.62), HADS-A (0.74, 95% CI 0.56;0.94) and mastery (1.10, 95% CI 0.88;1.31) occurred during the COVID year compared to previous years. Older adults with functional limitations or with frailty showed a smaller increase in feelings of mastery in the COVID-year. CONCLUSION: Our results suggest limited mental health effects on older adults from the first COVID-19 wave. Older adults have perhaps better coping strategies than younger adults, or preventive measures did not have extensive consequences for the daily life of older adults. Further monitoring of depression, anxiety and perceived mastery is recommended.

Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak.

BACKGROUND: Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus. AIMS: To assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH. METHODS: Observational study in a 185-bed NH with two consecutive testing strategies: testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment. RESULTS: 185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624). CONCLUSIONS: Symptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.

Asymptomatic Cases and Limited Transmission of SARS-CoV-2 in Residents and Healthcare Workers in Three Dutch Nursing Homes.

We aimed to assess the contribution of a- and presymptomatic residents and healthcare workers in transmission of SARS-CoV-2 in nursing homes. We conducted two serial point-prevalence surveys, including standardized symptom assessment and nasopharyngeal and oropharyngeal testing for SARS-CoV-2, among 297 residents and 542 healthcare workers of three Dutch nursing homes (NHs) with recent SARS-CoV-2 introduction. At the first point-prevalence survey, 15 residents tested positive of which one was presymptomatic and three remained asymptomatic. At the second point-prevalence survey one resident and one healthcare worker tested SARS-CoV-2 positive and both remained asymptomatic. Although a limited number of SARS-CoV-2 positive cases were identified, this study confirms a- and presymptomatic occurrence of Covid-19. We additionally describe factors that may contribute to the prevention of transmission. Taken together, our study complements the discussion on effective SARS-CoV-2 screening in NHs.