Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents
Coronavirus Disease 2019 Outcomes in French Nursing Homes That Implemented Staff Confinement With Residents
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DOI：
10.1001/jamanetworkopen.2020.17533
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发表时间：
2020-08-13
影响因子：
13.8
通讯作者：
Lafuente-Lafuente, Carmelo
中科院分区：
文献类型：
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作者：
Belmin, Joel;Um-Din, Nathavy;Lafuente-Lafuente, Carmelo
问题：与全国总体结果相比，2019冠状病毒病（COVID-19）大流行期间在法国养老院与居民一起进行自我隔离的工作人员是否与COVID-19相关的更好结果相关？这项队列研究包括17家工作人员自我隔离的养老院和9513家全国调查中的养老院，发现与全国调查记录的比率相比，工作人员自我隔离的养老院的居民与COVID-19相关的死亡率较低，居民和工作人员的COVID-19发病率较低。这些研究结果表明，养老院工作人员与居民的自我隔离可能有助于保护居民免受与COVID-19相关的死亡，并有助于保护居民和工作人员免受COVID-19感染。这项队列研究调查了2019年冠状病毒病在养老院的结果，在养老院，工作人员与居民隔离，与法国的全国总体结果进行了比较。2019冠状病毒病（COVID-19）是养老院的主要威胁。在2020年3月和4月袭击法国的COVID-19大流行浪潮期间，法国一些养老院的工作人员决定自愿与居民隔离，以降低严重急性呼吸综合征冠状病毒2进入该设施的风险。目的调查法国养老院实施工作人员与居民自愿隔离的covid -19相关结果。本回顾性队列研究于2020年3月1日至5月11日在法国养老院进行。参与者包括工作人员自愿自我隔离的养老院的居民和工作人员，以及工作人员不进行自我隔离的老年人设施的居民和工作人员。将自我隔离养老院队列中的COVID-19病例率和死亡率与法国卫生当局对养老院进行的基于人口的调查的结果进行了比较。从媒体中确定了有自我隔离工作人员的养老院，如果工作人员与居民的隔离期超过7天，则包括在内。主要结果和措施居民中与COVID-19相关的死亡率以及居民和工作人员中的COVID-19病例。初级保健或医院医生根据发热和呼吸体征（如咳嗽、呼吸困难）或与COVID-19相符的临床疾病诊断出COVID-19；如果鼻咽拭子严重急性呼吸综合征冠状病毒2型实时逆转录聚合酶链反应检测呈阳性，则认为确诊为COVID-19，如果未进行该检测或结果为阴性，则认为可能诊断为COVID-19。通过对有自我隔离工作人员的养老院的负责人进行电话采访，并通过向所有设施的卫生当局进行全国范围的申报调查，记录了COVID-19病例。结果本研究包括17家养老院，794名工作人员和1250名居民。全国调查包括9513个设施，385290名工作人员和695060名居民。与全国调查的4599家养老院（48.3%）相比，只有1家养老院（5.8%）的居民出现了COVID-19病例（P < 0.001）。与全国调查确诊病例30569例（4.4%）相比，有自我隔离工作人员的养老院确诊病例5例（0.4%）（P < .001）；与全国调查中可能感染新冠病毒的31799人（4.6%）相比，无自我隔离设施居民感染新冠病毒（P < 0.001）。在有工作人员自我隔离的养老院中，有5名居民（0.4%）死于COVID-19，而在全国调查中有12516人（1.8%）死于COVID-19（优势比为0.22；95% CI为0.09-0.53;P < 0.001）。自我隔离设施中确诊或可能感染新冠肺炎的工作人员为12人（1.6%），而全国调查的工作人员为29463人（7.6%）（P < 0.001）。在这项针对2019冠状病毒病大流行期间法国养老院的队列研究中，与全国调查相比，在实施工作人员隔离的养老院中，与COVID-19相关的死亡率较低。这些研究结果表明，与居民一起的工作人员的自我隔离可能有助于保护养老院居民免受与COVID-19相关的死亡，并有助于保护居民和工作人员免受COVID-19感染。
Question Was self-confinement of staff members with residents in French nursing homes during the coronavirus disease 2019 (COVID-19) pandemic associated with better outcomes related to COVID-19 compared with overall national outcomes? Findings This cohort study including 17 nursing homes with staff self-confinement and 9513 nursing homes in a national survey found that nursing homes with staff self-confinement experienced lower mortality related to COVID-19 among residents and lower incidence of COVID-19 among residents and staff members than rates recorded in a national survey. Meaning These findings suggest that self-confinement of nursing home staff members with residents may help protect residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.This cohort study examines coronavirus disease 2019 outcomes in nursing homes where staff self-confined with residents compared with overall national outcomes in France.Importance Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COVID-19 pandemic wave that hit France in March and April 2020, staff members of some French nursing homes decided to confine themselves with their residents on a voluntary basis to reduce the risk of entry of the severe acute respiratory syndrome coronavirus 2 into the facility. Objective To investigate COVID-19-related outcomes in French nursing homes that implemented voluntary staff confinement with residents. Design, Setting, and Participants This retrospective cohort study was conducted in French nursing homes from March 1 to May 11, 2020. Participants included residents and staff members of the nursing homes where staff participated in voluntary self-confinement as well as those of the facilities for elderly people where staff did not practice self-confinement. Rates of COVID-19 cases and mortality in the cohort of nursing homes with self confinement were compared with those derived from a population-based survey of nursing homes conducted by French health authorities. Exposures Nursing homes with staff who self-confined were identified from the media and included if the confinement period of staff with residents was longer than 7 days. Main Outcomes and Measures Mortality related to COVID-19 among residents and COVID-19 cases among residents and staff members. COVID-19 was diagnosed by primary care or hospital physicians on the basis of fever and respiratory signs (eg, cough, dyspnea) or a clinical illness compatible with COVID-19; COVID-19 diagnoses were considered confirmed if real-time reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal swab was positive and considered possible if the test had not been performed or results were negative. Cases of COVID-19 were recorded by a telephone interview with the directors of nursing homes with staff who self-confined and by a nationwide declaration survey to health authorities for all facilities. Results This study included 17 nursing homes in which 794 staff members confined themselves to the facility with their 1250 residents. The national survey included 9513 facilities with 385290 staff members and 695060 residents. Only 1 nursing home with staff who self-confined (5.8%) had cases of COVID-19 among residents, compared with 4599 facilities in the national survey (48.3%) (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined had confirmed COVID-19, compared with 30569 residents (4.4%) with confirmed COVID-19 in the national survey (P < .001); no residents of facilities with self-confinement had possible COVID-19, compared with 31799 residents (4.6%) with possible COVID-19 in the national survey (P < .001). Five residents (0.4%) in the nursing homes with staff who self-confined died of COVID-19, compared with 12516 (1.8%) in the national survey (odds ratio, 0.22; 95% CI, 0.09-0.53; P < .001). Twelve staff members (1.6%) from the facilties with self-confinement had confirmed or possible COVID-19, compared with 29463 staff members (7.6%) in the national survey (P < .001). Conclusions and Relevance In this cohort study of French nursing homes during the COVID-19 pandemic, mortality rates related to COVID-19 were lower among nursing homes that implemented staff confinement with residents compared with those in a national survey.These findings suggest that self-confinement of staff members with residents may help protect nursing home residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.