August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

Abstract

Purpose: The European Geriatric Medicine Society (EuGMS) is launching a second interim guidance whose aim is to prevent the entrance and spread of COVID-19 into long-term care facilities (LTCFs).

Methods: The EuGMS gathered experts to propose a guide of measures to prevent COVID-19 outbreaks in LTCFs. It is based on the specific features of SARS-CoV-2 transmission in LTCFs, residents' needs, and on experiences conducted in the field.

Results: Asymptomatic COVID-19 residents and staff members contribute substantially to the dissemination of COVID-19 infection in LTCFs. An infection prevention and control focal point should be set up in every LTCF for (1) supervising infection prevention and control measures aimed at keeping COVID-19 out of LTCFs, (2) RT-PCR testing of residents, staff members, and visitors with COVID-19 symptoms, even atypical, and (3) isolating subjects either infected or in contact with infected subjects. When a first LCTF resident or staff member is infected, a facility-wide RT-PCR test-retest strategy should be implemented for detecting all SARS-CoV-2 carriers. Testing should continue until no new COVID-19 cases are identified. The isolation of residents should be limited as much as possible and associated with measures aiming at limiting its negative effects on their mental and somatic health status.

Conclusions: An early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents and staff more promptly. Subsequently, an earlier testing for SARS-CoV-2 symptomatic and asymptomatic LTCF staff and residents will enable the implementation of appropriate infection prevention and control. The negative effects of social isolation in residents should be limited as much as possible.

Keywords: COVID-19; Guidance; Long-term care facility; SARS-CoV-2; Social isolation; rRT-PCR.

Box 1

Adaptation of Infection Prevention and Control Measures to SARS-CoV-2 Transmission Level in the Community nearby the LTCF or in the LTCF

Box 2

RT-PCR test properties useful when interpreting testing results in LTCF residents, staff members, or visitors [5, 12, 14, 15, 17, 18, 60]

Box 3

Tasks of the Infection Prevention Control (IPC) focal point in LTCFs

Box 4

Recommended hygiene and distancing measures in the daily life of the health care personnel, visitors, and residents who go outside the LTCF, for as long as the virus is circulating outside the LTCF

Box 5

Measures that should be taken by staff members, visitors, and residents before they enter the facility, whether COVID-19 positive or negative, for as long as the virus is circulating outside the LTCF, especially in areas with substantial community transmission

Box 6

Measures that should be taken by staff members, visitors, and residents during their stay in the LTCF for as long as the virus is circulating outside the LTCF, especially in areas with substantial community transmission

Box 7

Precautions for LTCF staff who enter the room of a patient with known or suspected COVID-19 [25, 30, 32, 44]