Examining the development and utilization of infection control policies to safely support adults with intellectual and developmental disabilities in congregate living settings during COVID-19.

OBJECTIVE: Congregate living settings supporting individuals with intellectual and developmental disabilities (IDD) have experienced unprecedented challenges during the COVID-19 pandemic. This study aimed to explore the development and utilization of infection control policies in congregate living settings supporting individuals with IDD during the COVID-19 pandemic. METHODS: This qualitative study employed an interpretive description using semi-structured interviews involving administrative personnel from agencies assisting those with IDD residing in Developmental Services congregate living settings in Ontario, Canada. RESULTS: Twenty-two semi-structured interviews were conducted with individuals from 22 agencies. Thematic analysis revealed three categories: Development of infection control policies, Implementation of infection control policies, and Impact of infection control policies. Each category yielded subsequent themes. Themes from the Development of infection control policies category included New responsibilities and interpreting the grey areas, and Feeling disconnected and forgotten. Four themes within the Implementation of infection control policies category included, "It's their home" (i.e. difficulty balancing public health guidance and organizational values), Finding equipment and resources (e.g. supports and barriers), Information overload (i.e. challenges agencies faced when implementing policies), and Emerging vaccination (i.e. perspective of agencies as they navigate vaccination for clients and staff). The category of Impact of infection control policies had one theme-Fatigue and burnout, capturing the impact of policies on stakeholders in congregate living settings. CONCLUSION: Agencies experienced difficulties developing and implementing infection control policies, impacting the clients they serve and their families and staff. Public health guidance should be tailored to each congregate living setting rather than generally applied.

RéSUMé: OBJECTIF: Les lieux d'hébergement collectif pour les personnes ayant une déficience intellectuelle ou de développement (DID) ont affronté des défis sans précédent durant la pandémie de la COVID-19. La présente étude vise à explorer l'élaboration et l'utilisation des politiques de prévention des infections dans les lieux d'hébergement collectif pour les personnes ayant une DID durant la pandémie de la COVID-19. MéTHODES: Cette étude qualitative repose sur la description interprétative lors d'entrevues semi-structurées auprès du personnel administratif des organismes qui viennent en aide aux personnes ayant une DID et résidant dans des lieux d'hébergement collectif en Ontario, au Canada. RéSULTATS: Au total, 22 entrevues semi-structurées ont été effectuées auprès de personnes provenant de 22 organismes. L'analyse thématique a révélé trois catégories : Élaboration des politiques de prévention des infections, mise en œuvre des politiques de prévention des infections, et impacts des politiques de prévention des infections. Chaque catégorie a généré des thèmes subséquents. Les thèmes liés à l'élaboration des politiques de prévention des infections comprenaient les nouvelles responsabilités et l'interprétation des zones grises, et le sentiment de détachement et d'avoir été oublié. Quatre thèmes découlant de la mise en œuvre des politiques de prévention des infections comprenaient « c'est leur maison ¼ (c'est-à-dire difficulté d'équilibrer les mesures de santé publique et les valeurs organisationnelles), trouver de l'équipement et des ressources (p. ex., mesures de soutien et obstacles), surcharge d'information (c'est-à-dire les défis qu'ont dû affronter les organismes lors de la mise en œuvre des politiques) et la vaccination émergente (notamment la perspective des organismes lorsqu'ils ont dû composer avec le processus de vaccination pour la clientèle et le personnel). La catégorie des impacts des politiques de prévention des infections avait un thème : la fatigue et l'épuisement professionnel, saisissant les impacts des politiques de prévention des infections dans les lieux d'hébergement collectif sur ses intervenants. CONCLUSION: Les organismes ont éprouvé des difficultés lors de l'élaboration et la mise en œuvre de politiques de prévention des infections, touchant ainsi leurs clients, leurs familles et leurs employés. Les mesures de santé publique devraient plutôt être adaptées à chaque lieu d'hébergement collectif, et non pas appliquées de façon générale.

Impacts of timing, length, and intensity of behavioral interventions to COVID-19 dynamics: North Carolina county-level examples.

We sought to examine how the impact of revocable behavioral interventions, e.g., shelter-in-place, varies throughout an epidemic, as well as the role that the proportion of susceptible individuals had on an intervention's impact. We estimated the theoretical impacts of start day, length, and intensity of interventions on disease transmission and illustrated them on COVID-19 dynamics in Wake County, North Carolina, to inform how interventions can be most effective. We used a Susceptible, Exposed, Infectious, and Recovered (SEIR) model to estimate epidemic curves with modifications to the disease transmission parameter (ß). We designed modifications to simulate events likely to increase transmission (e.g., long weekends, holiday seasons) or behavioral interventions likely to decrease it (e.g., shelter-in-place, masking). We compared the resultant curves' shape, timing, and cumulative case count to baseline and across other modified curves. Interventions led to changes in COVID-19 dynamics, including moving the peak's location, height, and width. The proportion susceptible, at the start day, strongly influenced their impact. Early interventions shifted the curve, while interventions near the peak modified shape and case count. For some scenarios, in which the transmission parameter was decreased, the final cumulative count increased over baseline. We showed that the timing of revocable interventions has a strong impact on their effect. The same intervention applied at different time points, corresponding to different proportions of susceptibility, resulted in qualitatively differential effects. Accurate estimation of the proportion susceptible is critical for understanding an intervention's impact. The findings presented here provide evidence of the importance of estimating the proportion of the population that is susceptible when predicting the impact of behavioral infection control interventions. Greater emphasis should be placed on the estimation of this epidemic component in intervention design and decision-making. Our results are generic and are applicable to other infectious disease epidemics, as well as to future waves of the current COVID-19 epidemic. Developed into a publicly available tool that allows users to modify the parameters to estimate impacts of different interventions, these models could aid in evaluating behavioral intervention options prior to their use and in predicting case increases from specific events.

Risk perception and emotional wellbeing in healthcare workers involved in rapid response calls during the COVID-19 pandemic: A substudy of a cross-sectional survey.

BACKGROUND: Coronavirus disease-2019 (COVID-19) has effected major changes to healthcare delivery within acute care settings. Rapid response calls (RRCs) in healthcare organisations have been effective at identifying and urgently managing acute clinical deterioration. Code-95 RRC were introduced to prewarn healthcare workers (HCWs) attending to patients suspected or confirmed with COVID-19 infection. AIMS: The primary aim of the study was to identify the personal impact of the COVID-19 pandemic on HCWs involved in attending Code-95 RRC. We sought to evaluate their perception of risks and effects on wellbeing and identify potential opportunities for improvement at organisational levels. METHODS: We undertook a detailed survey on HCWs attending Code-95 RRCs, including questions that sought to understand the impact of the pandemic as well as their perception of infection risk and emotional wellbeing. This was a substudy of the prospective cross-sectional single-centre survey of HCWs that was conducted over a 3-week period at Frankston Hospital, Victoria, Australia. We adopted a quantitative content analysis approach for free-text responses in this secondary analysis. RESULTS: Four hundred two free-text comments were received from 297 respondents and were analysed. More than two-thirds (68%, 223/297) were female. Of all comments, 39% (155/402) were related to organisational issues including communication, confusion due to constantly changing infection control policies, and insufficient training. Thirty-three percent of comments (133/402) raised issues regarding the adequacy of personal protective equipment. Anxiety was reported in 25% of comments (101/402) with concerns predominantly relating to emotional stress and fatigue, risks of virus exposure and transmitting the infection to others, and COVID-19 precautions impairing care delivery. CONCLUSION(S): Our study raises important issues that have relevance for all healthcare organisations in the management of patients with COVID-19. These include the importance of improving communication, especially when infection control policies are revised, optimising training, maintaining adequate personal protective equipment, and HCW support. Early recognition and management of these issues are crucial to maintain optimal healthcare delivery.