Variation inSARS-CoV-2 Prevalence inUSSkilled Nursing Facilities
Variation inSARS-CoV-2 Prevalence inUSSkilled Nursing Facilities
复制标题
DOI：
10.1111/jgs.16752
复制
发表时间：
2020-08-21
影响因子：
6.3
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
White, Elizabeth M.;Kosar, Cyrus M.;Mor, Vincent
目的了解专业护理机构中与严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)暴发相关的县和机构因素。设计横断面研究，将县SARS-CoV-2流行数据、行政数据、SNF爆发的州报告以及Genesis Healthcare的数据联系起来，Genesis Healthcare是一家提供急性后和长期护理的大型多州医疗服务提供商。报告的州数据截至2020年4月21日；Genesis的数据报告截至2020年5月4日。地点和对象Genesis样本由25个州的341个SNF组成，其中包括对所有居民进行普遍测试的SNF的子集。非Genesis样本包括Genesis运营的12个州发布疫情SNF名称的所有其他SNF(n=3,016)。Genesis和Non-Genesis SNF的测量：任何暴发(一名或多名SARS-CoV-2检测呈阳性的居民)。仅限于Genesis SNF：确诊病例数量、SNF病例病死率和普遍检测后的患病率。结果118例(34.6%)Genesis SNF和640例(21.2%)非Genesis SNF有暴发。每100,000例(1%)县发病率的差异与Genesis和非Genesis SNF的暴发概率差异33.6个百分点(95%可信区间=9.6-57.7个百分点；P=0.008)以及Genesis SNF每个机构12.5例的差异(95%CI=4.4-20.8例；P=0.003)相关。设施规模的10个床位的差异与暴发概率的0.9个百分点(95%CI=0.6-1.2个百分点；P<；.001)相关。我们发现疗养院比较五星级或过去感染控制缺陷的引用与暴发的概率或严重程度之间没有一致的关系。结论在SARS-CoV-2高流行地区，较大的SNF和SNF是暴发的高风险，必须有机会进行普遍检测，以发现病例，实施缓解策略，并防止进一步潜在的可避免的病例和相关并发症。
OBJECTIVE To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs). DESIGN Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6-57.7 percentage point;P =.008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4-20.8 cases;P =.003) for Genesis SNFs. A 10-bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6-1.2 percentage point;P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five-Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications.