SARS-CoV-2 spreads rapidly through skilled nursing facilities

Rapid and widespread transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur in skilled nursing facilities, according to a study published online April 24 in the New England Journal of Medicine.

11 MAY 2020--Melissa M. Arons, R.N., from the U.S. Centers for Disease Control and Prevention COVID-19 Emergency Response in Atlanta, and colleagues conducted two serial point-prevalence surveys one week apart among residents of a skilled nursing facility. Assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2; symptoms present in the previous 14 days were recorded. Asymptomatic residents who tested positive were reassessed after seven days.

The researchers found that 57 of 89 residents (64 percent) tested positive for SARS-CoV-2 23 days after the first positive test result in a resident at the skilled nursing facility. Forty-eight of 76 residents (63 percent) who participated in point-prevalence surveys tested positive. More than half (56 percent) of these 48 residents were asymptomatic at the time of testing; 24 of the 27 subsequently developed symptoms. The median real-time reverse-transcriptase polymerase chain reaction cycle threshold value was 23.1 in samples from these 24 presymptomatic residents; viable virus was recovered from 17 residents. Eleven of the 57 residents with SARS-CoV-2 infection had been hospitalized as of April 3, and 15 had died (26 percent mortality).

"Our data suggest that symptom-based strategies for identifying residents with SARS-CoV-2 are insufficient for preventing transmission in skilled nursing facilities," the authors write. "Once SARS-CoV-2 has been introduced, additional strategies should be implemented to prevent further transmission."

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More information: Abstract/Full Text
Editorial

Journal information: New England Journal of Medicine 

A quarter of nursing home residents are colonized with drug-resistant bacteria

The significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes, according to a meta-analysis published in the May issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

30 april 2017--The systematic literature review and meta-analysis, conducted by Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN, and others at the Columbia University School of Nursing, found the prevalence of MDR-GNB colonization among sampled nursing home residents ranged from 11.2 percent to 59.1 percent, with a pooled average of 27 percent. Researchers also found that nine of the 12 studies involved identi?ed speci?c factors that are associated with increased MDR-GNB colonization risk, including advanced age, gender, comorbid chronic diseases, history of recurrent hospitalization, increased interaction with healthcare workers, frequent antimicrobial exposure, delayed initiation of effective antibiotic therapy, presence of medical devices, decreased functional status, advanced dementia, nonambulatory status, fecal incontinence, severe sepsis present on admission, and residency in a long-term care facility.
The study is thought to be the first systematic review and meta-analysis of its kind, and should raise concerns among infection control professionals and nursing home facilities.
"This study underscores the importance of having strong infection prevention programs in all nursing homes and long-term care facilities," said 2017 APIC President Linda Greene, RN, MPS, CIC, FAPIC. "Understanding the dynamics and cause of MDR-GNB transmission is crucial to identifying effective infection control strategies speci?c to these settings."
Nursing home residents are especially vulnerable to infections due to multiple comorbidities, advanced age, and immune dysfunction. In addition, living in a nursing home is itself considered a risk factor, as frequent transfers from nursing homes to acute care contribute to the in?ux of pathogens into hospital settings. Prevention and management of MDR-GNB in nursing homes are complicated and require extensive infection control resources due to challenges common to this setting such as understaffing, fewer resources, insufficient training, and inadequate surveillance.
"Identifying which patients are most prone to an increased risk of MDR-GNB will enable infection preventionists to tailor efforts and stem future contaminations," wrote Aliyu, et al. "The results of our study suggest that there is much more to be done with regard to infection prevention within nursing homes, and that increased measures must be taken with elderly patients in regard to MDR-GNB colonization."
According to the Centers for Disease Control and Prevention, the percentage of gram-negative bacteria that are resistant to drugs is increasing. MDR-GNB cause serious infections in healthcare settings including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. They are particularly worrisome because they are becoming resistant to nearly all drugs that would be considered for treatment, with fewer novel antibacterial agents being developed.

More information: Sainfer Aliyu et al, Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis, American Journal of Infection Control (2017). DOI: 10.1016/j.ajic.2017.01.022


Provided by Elsevier

Study finds dogs, robots cheer elderly

By CHERYL WITTENAUER
Dogs may have a hard time wrapping their paws around this one: Robotic competition is nipping at their heels in the man's-best-friend department. A study by Saint Louis University found that a lovable pooch named Sparky and a robotic dog, AIBO, were about equally effective at relieving the loneliness of nursing home residents and fostering attachments.
The study, which appears in the March issue of the Journal of The American Medical Directors Association, builds on previous findings by the researchers that frequent dog visits decreased loneliness of nursing home residents.
Andrew Ng, who leads Stanford University's team in building a home-assistance robot and was not involved in the study, said the strength of the research is very encouraging.
If humans can feel an emotional bond with robots, even fairly simple ones, some day they could "not just be our assistants, but also our companions," he said.
To test whether residents responded better to Sparky, a trained therapy dog, or the Sony-made robot dog, researchers divided 38 nursing home residents into three groups at a trio of long-term care facilities in St. Louis.
One group had weekly, 30-minute one-on-one visits with Sparky; another group had similar visits with AIBO; a control group did not visit with either dog. Their level of loneliness — determined by residents' answers to several questions — was tested at the beginning and near the end of eight weeks of visits.
Investigator Marian Banks delivered the dogs, but did not interact with the residents. In the end, both groups were less lonely and more attached.
Most of the elderly used Sparky, a 9-year-old, reddish-brown mutt with a white muzzle and floppy ears, as a confidant, telling him "their life story," Marian Banks said.
"He listened attentively, wagged his tail, and allowed them to pet him," said Banks, who adopted and trained Sparky after finding him in an alley behind her home seven years ago.
Those who visited with AIBO took a little longer — about a week — to warm up to the metallic creature. Over time, they grew more comfortable with AIBO, and petted and talked to him. He responded by wagging his tail, vocalizing and blinking his lights.
"AIBO is charismatic if you start to interact with him," said the study's author, Dr. William Banks, a professor of geriatric medicine at Saint Louis University. "He's an engaging sort of guy."
The research could mean that a world is possible where robots could substitute for living dogs and help people, William Banks said.
"They could be personal, not an intrusive crazy inanimate object," he said.
Sara Kiesler, professor of computer science and human-computer interaction at Carnegie Mellon University who was not involved in the study, said the results of the study are encouraging but not completely convincing.
The problem is inferring it was the robotic dog that reduced the loneliness, and not the human who brought him into the room, she said. She said another study could compare a visit from AIBO with someone stopping by with a stuffed animal or even just a candy bar.
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Journal of The American Medical Directors Association: http://www.jamda.com/