Recommendations for protecting against and mitigating the COVID-19 pandemic in long-term care facilities

Abstract

The COVID-19 outbreak has drawn heightened attention from public health scholars researching ways to limit its spread. Much of the research has been focused on minimizing transmission in hospitals and in the general community. However, a particularly vulnerable community that has received relatively little attention is elders residing in long-term care facilities (LTCFs). In this article we address this relative lack of attention, arguing that enhanced traffic control bundling (eTCB) can and should be adopted and implemented as a means of protecting LTCF residents and staff. Enhanced TCB has been widely applied in hospital settings and has proven effective at limiting droplet and fomite transmissions both within hospitals and between hospitals and the general community. By effectively adapting eTCB to LTCF conditions, particularly by incorporating compartmentalization within zones plus active surveillance, COVID-19 transmission into and throughout LTCFs can be minimized, thereby saving numerous lives among an especially vulnerable population.

Keywords: COVID-19; Compartmentalization; Enhanced traffic control bundling; Long-term care facility; Mitigation; Pandemic.

Figure 1

Compartmentalization in long-term care facilities (LTCFs). The goal of compartmentalization in LTCFs is to supplement enhanced traffic control bundling as a further means of limiting COVID-19 (or other infectious disease) transmission. According to this approach, LTCFs establish distinct compartments within clean zones. Each compartment is staffed by healthcare workers and support staff who are specifically designated to that compartment. Compartments are, ideally, in separate buildings. However, since this is rarely an option, separate floors in the same building or even clearly differentiated zones on the same floor are options. Movement among compartments should be minimized, but when necessary must involve proper hand hygiene at designated hand disinfection checkpoints established between each compartment. TOCC, travel, occupation, contact, and cluster.