Evaluation of a state-wide effort to improve COVID-19 infection control in Massachusetts nursing homes

Abstract

Background: During the deadly 2020 SARS-CoV-2 surge in nursing homes (NHs), Massachusetts (MA) initiated a multicomponent infection control intervention to mitigate its spread.

Methods: We aimed to assess the intervention's impact by comparing the weekly risk of PCR-confirmed infections among MA NH residents to those in neighboring New England states, all managed similarly by a single NH provider. We studied 2085 residents in 20 MA NHs and 4493 residents in 45 comparator facilities. The intervention included: (1) A 28-item infection control checklist of best practices, (2) incentive payments to NHs contingent on scoring ≥24 on the checklist, meeting 6 core competencies, testing residents and staff for SARS-COV-2 RNA, uploading data, and enabling virtual visits; (3) on-site and virtual infection control consultations for deficient facilities; (4) 6 weekly webinars; (5) continuous communication with the MA Department of Public Health; and (6) access to personal protective equipment, temporary staff, and SARS-CoV-2 testing. Weekly rates of infection were adjusted for county COVID-19 prevalence.

Results: The adjusted risk of infection started higher in MA, but declined more rapidly in its NHs compared to similarly managed facilities in other states. The decline in infection risk during the early intervention period was 53% greater in MA than in Comparator States (state-by-time interaction HR = 0.47; 95% CI 0.37-0.59). By the late intervention period, the risk of infection continued to decline in both groups, and the change from baseline in MA was marginally greater than that in the Comparator States (interaction HR 0.80; 95% CI 0.64-1.00).

Conclusions: The MA NH intervention was associated with a more rapid reduction in the rate of SARS-CoV-2 infections compared to similarly managed NHs in neighboring states. Although several unmeasured factors may have confounded our results, implementation of the MA model may help rapidly reduce high rates of infection and prevent future COVID-19 surges in NHs.

Keywords: COVID-19 intervention; SARS-CoV-2; infection control; long-term care; public health.

FIGURE 1

Weekly risk of infection by study period. Model‐adjusted point estimates and 95% confidence intervals are displayed. The apparent effect attributable to the intervention is most evident during the early intervention phase (study weeks 6–9); during this 3‐week period the likelihood of infection declined more rapidly in Massachusetts than in the neighboring states. To 20 weeks, the cumulative decline in Massachusetts was likewise greater than in neighboring states, such that the greater likelihood of infection observed at baseline had largely been removed.