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Staffing and Protective Equipment Access Mitigated COVID-19 Penetration and Spread in US Nursing Homes During the Third Surge.
Simoni-Wastila, Linda; Wallem, Alexandra; Fleming, Sean P; Le, Tham T; Kepczynska, Paulina; Yang, Jeanne; Qato, Danya M.
  • Simoni-Wastila L; University of Maryland School of Pharmacy, Baltimore, MD, USA; The Peter Lamy Center on Drug Therapy and Aging, Baltimore, MD, USA.
  • Wallem A; University of Maryland School of Pharmacy, Baltimore, MD, USA.
  • Fleming SP; University of Maryland School of Pharmacy, Baltimore, MD, USA; The Peter Lamy Center on Drug Therapy and Aging, Baltimore, MD, USA.
  • Le TT; University of Maryland School of Pharmacy, Baltimore, MD, USA.
  • Kepczynska P; University of Maryland School of Pharmacy, Baltimore, MD, USA.
  • Yang J; University of Maryland School of Pharmacy, Baltimore, MD, USA.
  • Qato DM; University of Maryland School of Pharmacy, Baltimore, MD, USA; The Peter Lamy Center on Drug Therapy and Aging, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: dqato@rx.umaryland.edu.
J Am Med Dir Assoc ; 22(12): 2504-2510, 2021 12.
Article in English | MEDLINE | ID: covidwho-1517313
ABSTRACT

OBJECTIVES:

During the last quarter of 2020-despite improved distribution of personal protective equipment (PPE) and knowledge of COVID-19 management-nursing homes experienced the greatest increases in cases and deaths since the pandemic's beginning. We sought to update COVID-19 estimates of cases, hospitalization, and mortality and to evaluate the association of potentially modifiable facility-level infection control factors on odds and magnitude of COVID-19 cases, hospitalizations, and deaths in nursing homes during the third surge of the pandemic.

DESIGN:

Cross-sectional analysis. SETTING AND

PARTICIPANTS:

Facility-level data from 13,156 US nursing home facilities.

METHODS:

Two series of multivariable logistic regression and generalized linear models to examine the association of infection control factors (personal protective equipment and staffing) on incidence and magnitude, respectively, of confirmed COVID-19 cases, hospitalizations, and deaths in nursing home residents reported in the last quarter of 2020.

RESULTS:

Nursing homes experienced steep increases in COVID-19 cases, hospitalizations, and deaths during the final quarter of 2020. Four-fifths (80.51%; n = 10,592) of facilities reported at least 1 COVID-19 case, 49.44% (n = 6504) reported at least 1 hospitalization, and 49.76% (n = 6546) reported at least 1 death during this third surge. N95 mask shortages were associated with increased odds of at least 1 COVID-19 case [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.05-1.40] and hospitalization (1.26, 95% CI 1.13-1.40), as well as larger numbers of hospitalizations (1.11, 95% CI 1.02-1.20). Nursing aide shortages were associated with lower odds of at least 1 COVID-19 death (1.23, 95% CI 1.12-1.34) and higher hospitalizations (1.09, 95% CI 1.01-1.17). The number of nursing hours per resident per day was largely insignificant across all outcomes. Of note, smaller (<50-bed) and midsized (50- to 150-bed) facilities had lower odds yet higher magnitude of all COVID outcomes. Bed occupancy rates >75% increased odds of experiencing a COVID-19 case (1.48, 95% CI 1.35-1.62) or death (1.25, 95% CI 1.17-1.34). CONCLUSIONS AND IMPLICATIONS Adequate staffing and PPE-along with reduced occupancy and smaller facilities-mitigate incidence and magnitude of COVID-19 cases and sequelae. Addressing shortcomings in these factors is critical to the prevention of infections and adverse health consequences of a next surge among vulnerable nursing home residents.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article Affiliation country: J.jamda.2021.09.030

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: J Am Med Dir Assoc Journal subject: History of Medicine / Medicine Year: 2021 Document Type: Article Affiliation country: J.jamda.2021.09.030