A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

Journal article


Frazer, Kate, Mitchell, Lachlan, Stokes, Diarmuid, Lacey, Ella, Crowley, Eibhlin and Kelleher, Cecily C.. (2021). A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19. BMJ Open. 11(10), p. Article e047012. https://doi.org/10.1136/bmjopen-2020-047012
AuthorsFrazer, Kate, Mitchell, Lachlan, Stokes, Diarmuid, Lacey, Ella, Crowley, Eibhlin and Kelleher, Cecily C.
Abstract

Objectives The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors.

Setting Long-term care facilities.

Participants Residents, staff and visitors of facilities.

Primary and secondary outcome measures Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted.

Results The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents.

Conclusions Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF.

PROSPERO registration number CRD42020191569.

Year2021
JournalBMJ Open
Journal citation11 (10), p. Article e047012
PublisherBMJ Publishing Group
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2020-047012
PubMed ID34663652
Scopus EID2-s2.0-85117765733
PubMed Central IDPMC8523961
Open accessPublished as ‘gold’ (paid) open access
Page range1-16
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online18 Oct 2021
Publication process dates
Accepted29 Aug 2021
Deposited28 Nov 2022
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