Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 2;23(1):618.
doi: 10.1186/s12877-023-04319-w.

Learning from the covid-19 outbreaks in long-term care facilities: a systematic review

Helga Rafael Henriques  1 , Diana Sousa  2 , José Faria  2 , Joana Pinto  2 , Andreia Costa  2   3 , Maria Adriana Henriques  2   3 , Maria Cândida Durão  2
Affiliations

Learning from the covid-19 outbreaks in long-term care facilities: a systematic review

Helga Rafael Henriques et al. BMC Geriatr. .

Abstract

Background: The COVID-19 pandemic has devastatingly affected Long-Term Care Facilities (LTCF), exposing aging people, staff members, and visitors. The world has learned through the pandemic and lessons can be taken to adopt effective measures to deal with COVID-19 outbreaks in LTCF. We aimed to systematically review the available evidence on the effect of measures to minimize the risk of transmission of COVID-19 in LTCs during outbreaks since 2021.

Methods: The search method was guided by the preferred reporting items for systematic reviews (PRISMA) and the reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. The search was performed in April 2023. Observational and interventional studies from the databases of PubMed, Web of Science, Scopus, Cochrane Systematic Reviews, CINAHL, and Academic Search were systematically reviewed. We included studies conducted in the LTCF with outbreaks that quantitatively assess the effect of non-pharmacological measures on cases of COVID-19. Two review authors independently reviewed titles for inclusion, extracted data, and undertook the risk of bias according to pre-specified criteria. The quality of studies was analyzed using the Joanna Briggs Institute Critical Appraisal.

Results: Thirteen studies were included, with 8442 LTCF experiencing COVID-19 outbreaks and 598 thousand participants (residents and staff members). Prevention and control of COVID-19 infection interventions were grouped into three themes: strategic, tactical, and operational measures. The strategic measures reveal the importance of COVID-19 prevention and control as LTCF structural characteristics, namely the LTCF size, new admissions, infection control surveillance, and architectural structure. At the tactical level, the lack of personal and long staff shifts is related to COVID-19's spread. Operational measures with a favorable effect on preventing COVID-19 transmission are sufficient. Personal protective equipment stock, correct mask use, signaling, social distancing, and resident cohorting.

Conclusions: Operational, tactical, and strategic approaches may have a favorable effect on preventing the spread of COVID-19 in LTCFs experiencing outbreaks. Given the heterogeneous nature of the measures, performing a meta-analysis was not possible. Future research should use more robust study designs to explore similar infection control measures in LTCFs during endemic situations with comparable outbreaks.

Trial registration: The protocol of this systematic review was registered in PROSPERO (CRD42020214566).

Keywords: COVID-19; Disease transmission; Homes for the aged; Infection control; Infectious; Nursing.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Flowchart
Fig. 2
Fig. 2
Strategic measures to prevent the spread of COVID-19 in LTCFs experiencing outbreaks
Fig. 3
Fig. 3
Tactic measures to prevent the spread of COVID-19 in LTCFs experiencing outbreaks
Fig. 4
Fig. 4
Operational measures to prevent the spread of COVID-19 in LTCFs experiencing outbreaks
Fig. 5
Fig. 5
Combined measures to prevent the spread of COVID-19 in LTCFs experiencing outbreaks
Fig. 6
Fig. 6
Specific measures for COVID-19 outbreak containment
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lansbury LE, Brown CS, Nguyen-Van-Tam JS. Influenza in long-term care facilities. Influenza Other Respir Viruses. 2017;11(5):356–366. - PMC - PubMed
    1. Hand J, Rose EB, Salinas A, Lu X, Sakthivel SK, Schneider E, et al. Severe respiratory illness outbreak associated with human Coronavirus NL63 in a long-term care facility. Emerg Infect Dis. 2018;24(10):1964–1966. - PMC - PubMed
    1. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a long-term care facility in king county. Washington New England J Medicine. 2020;382(21):2005–2011. - PMC - PubMed
    1. Zhang XS, Charland K, Quach C, Nguyen QD, Zinszer K. Institutional, therapeutic, and individual factors associated with 30-daymortality after COVID-19 diagnosis in Canadian long-term care facilities. J Am Geriatr Soc. 2022;70(11):3210–3220. - PMC - PubMed
    1. European Centre for Disease Prevention and Control. Surveillance of COVID-19 in long-term care facilities in the EU/EEA, November 2021. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-COVID-19-lo....

Publication types