A new study details how Michigan nursing homes have limited the spread of the coronavirus.

Review by Emily Henderson, Bachelor of ScienceOctober 13, 2020

Seven months ago, the United States first heard a surge in COVID-19 deaths at a nursing home in Washington. This is an early warning sign of how the coronavirus passes through such facilities. Since then, more than 40% of Americans killed by pandemics have lived in nursing homes.

A new study now details how three nursing homes in Michigan limited the spread of coronavirus within the wall after the first case was diagnosed at its early peak. ..

Survey results published in Journal of the American Geriatrics Society, Can inform you of ongoing efforts to protect local and national nursing home residents.

All three nursing homes surveyed have already fallen into a pandemic with a proactive partnership-based approach to general infection prevention and a response plan that paves the way for effective COVID-19 containment.

This was partially made possible by a formal pre-COVID connection with the University of Michigan’s Academic Medical Center, Michigan Medicine.

This includes regular meetings between embedded UM geriatric physicians and nurse practitioners, institutional clinical and management team members, and a long history of involvement in UM research. Nursing homes were also actively working with the county health department.

Rapid action and testing

With these plans in place, the three institutions were able to take immediate action when coronavirus cases began to occur in Michigan in mid-March.

One of the cornerstones of their response: a COVID-19 viral DNA test provided through the in-house diagnostic laboratory of Michigan Medicine, with results available within 24 hours or up to 2 days.

Aggressive testing of symptomatic and asymptomatic residents, as well as timely test results, played an important role in containing the outbreak of COVID-19 at these facilities, the authors say. The in-house laboratory prioritized samples from nursing homes, resulting in results much faster than the first commercial laboratories used.

As soon as we heard of a case at a nursing home in Washington, we took a point prevalence test effort to test asymptomatic residents in addition to testing symptomatic individuals to reduce infection. Cooperated to devise. As a result, nursing home staff have made great efforts to prevent further spread to uninfected residents. “

Ana Montoya, MD, MPH, Study First Author, Medical Director for Sub-Acute Care, Michigan Medicine-University of Michigan

Montoya’s co-authors have been studying transmission and prevention of infections in nursing homes for over a decade and were the lead authors of a paper on pandemic preparation in nursing homes in Michigan in April, Lona Mody, MD, M. .Sc. It is included. Of COVID-19. She also consulted the Center for Health Research and Transformation for an independent report on Nursing Homes and COVID-19 in Michigan.

“I was particularly pleased to see different teams come together for a common purpose at the moment of the crisis,” says Mody. “We knew that even a small delay would have enormous consequences. Our experience shows the incredible value of research, cooperation and connections. Our work is by COVID-19. We hope to help state-level and national actions to limit catastrophic consequences. “

Prophylactic testing has recently become a federal requirement, and its frequency depends on the level of COVID-19 activity in the surrounding area. Nursing homes are also subject to reporting requirements and fines if they do not report test results.

However, in recent weeks, the government has sent a rapid nursing home tester that is less sensitive than the “gold standard” viral DNA test used in the study. Researchers say more research is needed on the impact of this approach.

“While rapid testing machines allow facilities to perform their own tests, most facilities still struggle with how to get the most out of the machine,” said the study’s corresponding author, Geriatrics. Said Grace Jenck, MD, an expert and deputy chief clinical director of the post. Emergency treatment in Michigan medicine.

“These rapid testers are likely to be used to test symptomatic residents and staff. Test results are available within minutes, so they quickly separate and take care of the PPE personally. Can be deployed to staff. Negative tests should continue. Repeat using a more sensitive PCR test. “

Test to stop spreading

Twenty-nine of the 215 residents in the three nursing homes in Michigan surveyed were diagnosed with COVID-19 from mid-March to late April. About half required hospitalization and 6 died within 14 days of diagnosis.

Sixteen of the cases were found by testing symptomatic populations from March 23 to early April.

However, after aggressively testing asymptomatic residents in early April, only one case of symptomatic COVID-19 was identified in each nursing home surveyed by April 23.

The blitz was important because it detected 10 infected but asymptomatic residents. That is, it may have been asymptomatic or presymptomatic. This represents 4.7% of all residents.

Six of the ten residents developed symptoms within days of the test. This means that if no infection is detected, the virus may have spread to other residents or staff. None of them required hospital care.

The test “Dengeki” was conducted in one day at each facility in early April. During this time, it was very rare to test a person without symptoms. This allowed the designated COVID-19 section of the facility to keep residents with infected but asymptomatic nursing homes away from other residents.

Over 600 staff have also been tested. 3.8% were positive and were told to stay home until the risk of viral infection was reduced.

Although the new study does not include long-term infection patterns, the authors state that the numbers of infections in the three nursing homes remain low. The fourth nursing home, also affiliated with Michigan Medicine, did not report cases of COVID-19 during the peak months of March and April.

Implementation of existing plans

As soon as symptoms are diagnosed or the COVID test returns positive, the nursing home follows a plan to move COVID-19-positive residents to a dedicated building with a team that only cares for COVID-positive residents. It was.

The creation of the COVID-19 Wing was a joint effort among all nursing home staff, including staff who are not normally involved in the care and cleaning of direct residents. The management staff helped move the furniture.

Montoya says the clinical team has worked creatively to reduce unnecessary interactions between staff and patients infected with the virus.

This included changing the frequency of medications, potential procedures for aerosolizing the virus, and temporary reductions in regular blood draws and other tests. Nursing homes have implemented alternative bathing options when the resident’s temporary room does not have a shower and arranged to provide services instead of having them leave the room for treatment or meals.

Staff working in multiple nursing homes, including those not in Michigan’s healthcare facilities, were asked to choose one and work exclusively there to prevent the virus from being carried between facilities.

Importantly, the staff received hazard pay, meals, and even a dedicated space to stay overnight at one nursing home to prevent the virus from being brought back to the family. A special rest area has been created in the area previously used for co-resident activities, allowing staff to decompress and eat during stressful times.

Facility leaders contacted residents, medical professionals, and families about the tests and results. We have embarked on an intensive cleaning and re-education effort for staff regarding the use of personal protective equipment. Companies that own nursing homes have also made special efforts to obtain sufficient PPE for the missing staff.