ABSTRACT
Background The COVID-19 pandemic has resulted in significant morbidity and mortality in aged care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially with relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities on SARS-CoV-2 attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from five databases using a registered search strategy with PROSPERO. Meta-regression analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in facility and staff per 100 beds Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate among residents was 42.0% (95% CI: 38.0-47.0%) and 21.7% (95% CI: 15.0-28.4%) in staff. Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusion The design of aged care facilities should have smaller-sized facilities with adequate space for social distancing.