COVID-19 Nursing Home Aggression and Partnership Outcomes During a Pandemic

Seven months ago, the United States first heard a surge in COVID-19 deaths at nursing homes 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 Michigan nursing homes restricted 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 have already implemented response plans that pave 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.

What is the impact

With these plans in place, three nursing homes could quickly take action when a coronavirus case began to occur in Michigan in mid-March.

One of the cornerstones of their response is the COVID-19 viral DNA test provided through Michigan Medicine’s in-house diagnostic laboratory, 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 said. The in-house laboratory prioritized samples from nursing homes, resulting in results much faster than the first commercial laboratories used.

Such preventative testing has recently become a federal requirement, the frequency of which 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. Further research is needed on the impact of this approach.

Stop spread

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 caught by testing symptomatic populations between March 23 and early April.

However, after aggressively testing asymptomatic residents in early April, only one case of symptomatic COVID-19 was identified at 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.

Existing plan

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. The clinical team worked creatively to reduce unnecessary interactions between staff and patients infected with the virus, the authors said.

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.

Big trend

Medicare and Medicaid Service Centers in Nursing Homes Coronavirus test staff In late August. This was a change from the previous policy of simply encouraging staff to take the test.

Nursing homes that do not meet staff testing requirements are at risk of discontinuing participation in Medicare and Medicaid programs. They are cited as breaches and, based on the severity of the breach, may face enforcement sanctions such as civil fines of over $ 400 per day or, in the case of breach, over $ 8,000. The surveyor will inspect the compliance of the nursing home.

Government helps facilities offset testing costs through $ 2.5 billion in funding, in addition to $ 5 billion already approved by the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund doing.

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