Staffing and Protective Equipment Access Mitigated COVID-19 Penetration and Spread in US Nursing Homes During the Third Surge.
Staffing and Protective Equipment Access Mitigated COVID-19 Penetration and Spread in US Nursing Homes During the Third Surge.
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DOI：
10.1016/j.jamda.2021.09.030
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发表时间：
2021-12
影响因子：
7.6
通讯作者：
Qato DM
中科院分区：
文献类型：
--
作者：
Simoni-Wastila L;Wallem A;Fleming SP;Le TT;Kepczynska P;Yang J;Qato DM
在2020年最后一个季度，尽管个人防护装备（PPE）的分配有所改善，对COVID-19管理的了解也有所改善，但疗养院的病例和死亡人数仍出现了自大流行开始以来的最大增幅。我们试图更新COVID-19病例、住院和死亡率的估计值，并评估在第三次大流行期间，潜在可修改的设施级感染控制因素与疗养院COVID-19病例、住院和死亡的几率和程度之间的关联。横截面分析。来自13156个美国养老院设施的设施级数据。采用两组多变量logistic回归和广义线性模型，分别研究了2020年第四季度养老院确诊病例、住院病例和死亡病例与感染控制因素（个人防护装备和人员配备）之间的关系。2020年最后一个季度，疗养院的COVID-19病例、住院和死亡人数急剧增加。在第三次激增期间，五分之四（80.51%;n = 10,592）的设施报告了至少1例COVID-19病例，49.44% （n = 6504）报告了至少1例住院治疗，49.76% （n = 6546）报告了至少1例死亡。N95口罩短缺与至少1例COVID-19病例的几率增加[优势比（OR） 1.21, 95%置信区间（CI） 1.05-1.40]和住院（1.26,95% CI 1.13-1.40）以及住院人数增加（1.11,95% CI 1.02-1.20）相关。护理人员短缺与至少1例COVID-19死亡的较低几率（1.23,95% CI 1.12-1.34）和较高住院率（1.09,95% CI 1.01-1.17）相关。每位住院医师每天的护理小时数在所有结果中基本上是微不足道的。值得注意的是，小型（<50张床）和中型（50至150张床）设施的所有COVID结果的几率较低，但程度较高。床位入住率高达75%，增加了COVID-19病例（1.48,95% CI 1.35-1.62）或死亡（1.25,95% CI 1.17-1.34）的几率。充足的人员配备和个人防护措施，以及减少占用和缩小设施，可降低COVID-19病例和后遗症的发生率和规模。解决这些因素的缺点对于预防感染和弱势养老院居民下一次激增的不良健康后果至关重要。
During the last quarter of 2020—despite improved distribution of personal protective equipment (PPE) and knowledge of COVID-19 management—nursing homes experienced the greatest increases in cases and deaths since the pandemic's beginning. We sought to update COVID-19 estimates of cases, hospitalization, and mortality and to evaluate the association of potentially modifiable facility-level infection control factors on odds and magnitude of COVID-19 cases, hospitalizations, and deaths in nursing homes during the third surge of the pandemic. Cross-sectional analysis. Facility-level data from 13,156 US nursing home facilities. Two series of multivariable logistic regression and generalized linear models to examine the association of infection control factors (personal protective equipment and staffing) on incidence and magnitude, respectively, of confirmed COVID-19 cases, hospitalizations, and deaths in nursing home residents reported in the last quarter of 2020. Nursing homes experienced steep increases in COVID-19 cases, hospitalizations, and deaths during the final quarter of 2020. Four-fifths (80.51%; n = 10,592) of facilities reported at least 1 COVID-19 case, 49.44% (n = 6504) reported at least 1 hospitalization, and 49.76% (n = 6546) reported at least 1 death during this third surge. N95 mask shortages were associated with increased odds of at least 1 COVID-19 case [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.05-1.40] and hospitalization (1.26, 95% CI 1.13-1.40), as well as larger numbers of hospitalizations (1.11, 95% CI 1.02-1.20). Nursing aide shortages were associated with lower odds of at least 1 COVID-19 death (1.23, 95% CI 1.12-1.34) and higher hospitalizations (1.09, 95% CI 1.01-1.17). The number of nursing hours per resident per day was largely insignificant across all outcomes. Of note, smaller (<50-bed) and midsized (50- to 150-bed) facilities had lower odds yet higher magnitude of all COVID outcomes. Bed occupancy rates >75% increased odds of experiencing a COVID-19 case (1.48, 95% CI 1.35-1.62) or death (1.25, 95% CI 1.17-1.34). Adequate staffing and PPE—along with reduced occupancy and smaller facilities—mitigate incidence and magnitude of COVID-19 cases and sequelae. Addressing shortcomings in these factors is critical to the prevention of infections and adverse health consequences of a next surge among vulnerable nursing home residents.
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影响因子：
13.8
作者：
Mehta HB;Li S;Goodwin JS
通讯作者：
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影响因子：
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作者：
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DOI：
10.1016/j.jamda.2020.06.016
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影响因子：
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通讯作者：
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影响因子：
6.3
作者：
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通讯作者：
Cai, Xueya