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Routine testing of staff, hand hygiene and PPE are most effective methods for controlling Covid-19 in care homes

Coronavirus

Routine testing of staff combined with strict hygiene and use of personal protective equipment (PPE) is the most effective method of preventing COVID-19 transmission in care home settings, a study finds.

The COVID-19 pandemic has had a devastating impact on care home residents throughout the world, and in Scotland care home residents account for 47% of all COVID-19 deaths.

The study by researchers at the University of Strathclyde, published in the journal Infection Control & Hospital Epidemiology, used ‘agent based modelling’ – a method to simulate the actions of autonomous individuals – to investigate the transmission dynamics of COVID-19 in a care home setting and the effectiveness of a range of infection control strategies.

In their study, the researchers explored a representative care home in Scotland as base case along with other care home setups in an uncertainty analysis.

They then evaluated the effectiveness of nine different intervention strategies, in the presence of a reference intervention strategy, in controlling the spread of COVID-19.

The reference intervention strategy was based on discussions with care home stakeholders in Lanarkshire and aligned with Scottish Government guidance which includes hand hygiene, use of PPE, 14-day isolation of symptomatic cases and restricted visiting hours.

Control measures

PhD candidate Le Khanh Ngan Nguyen of the Department of Management Science and lead author said:  “Our model predictions suggest that routine testing of staff, combined with strict hand hygiene and use of PPE to reduce risk of transmission per contact is the most effective method of controlling the spread of COVID-19.

“This strategy is as effective as more stringent interventions, such as routine testing of residents and 14-day compulsory isolation periods for new admissions. Routine testing of residents does not show additional effect compared to the reference intervention strategy.

“Infection control interventions in care homes need to not only be effective in containing the spread of COVID-19 but also feasible to implement in this special setting which is both a healthcare institution and a home.”

In all modelling scenarios the mean prevalence of infected residents peaked approximately 30 days after the first infection in the care home, decreased then stabilised after around 90 days.

In the absence of any control measures and spontaneous changes in the behaviours of individuals, the introduction of a single infected resident resulted in an outbreak where at least two residents died in 99.7% of simulations.

Co-author Dr Itamar Megiddo of the Department of Management Science, added: “Our simulations show that once COVID-19 is introduced into care homes, it spreads very quickly and stopping the spread is very difficult.

Care homes are integral to the wider healthcare system and it is essential that they continue to function safely and effectively amidst COVID-19 to avoid increasing the pressure on the acute care sector.

“If care homes stop admitting patients discharged from hospitals, patients have to stay in hospitals longer than they need, putting them at greater risk, adding to the pressure on hospitals, and causing tremendous distress for many individuals.”

The study also involved staff from Adult Services, Health & Social Care North Lanarkshire and Public Health Medicine, National Health Services Lanarkshire.