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. 2020 Nov;68(11):2447-2453.
doi: 10.1111/jgs.16832. Epub 2020 Sep 21.

Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homes

Lewis A Lipsitz  1   2   3 , Alida M Lujan  4 , Alyssa Dufour  1   2   3 , Gary Abrahams  5 , Helen Magliozzi  5 , Laurie Herndon  1 , Mohammad Dar  6
Affiliations

Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homes

Lewis A Lipsitz et al. J Am Geriatr Soc. 2020 Nov.

Abstract

Background/objectives: In April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28-point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes.

Design: Longitudinal cohort study.

Setting: A total of 360 Massachusetts NHs.

Participants: The Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123 "special focus" facilities with infection control deficiencies for on-site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed of resources for the acquisition of personal protective equipment (PPE), backup staff, and SARS-CoV-2 testing.

Measurements: We used two data sources: (1) four state audits of all NHs, and (2) weekly NH reports to the Massachusetts Center for Health Information and Analysis. Primary independent process measures were the checklist scores and adherence to each of its six core competencies. Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff. We used a hurdle mixed effects model adjusted for county COVID-19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths.

Results: Both resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups. Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates.

Conclusion: This statewide effort could serve as a national model for other states to prevent the devastating effects of pandemics such as COVID-19 in frail NH residents.

Keywords: SARS-CoV-2; coronavirus; infection control; long-term care.

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Conflict of interest statement

The authors have declared no conflicts of interest for this article.

Figures

Figure 1
Figure 1
Weekly rates of (A) COVID‐19 infection, (B) hospitalizations, and (C) mortality for Massachusetts nursing home residents during the 9‐week intervention period. Rates for special focus facilities are plotted with triangles (N = 123); rates for other facilities (N = 237) are plotted with squares.
Figure 2
Figure 2
Weekly rates of (A) COVID‐19 infection and (B) nursing care hours per patient day (HPPD) for Massachusetts nursing home staff during the 9‐week intervention period. Rates for special focus facilities are plotted with triangles (N = 123); rates for other facilities (N = 237) are plotted with squares.
See this image and copyright information in PMC

References

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