Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Setting
2.3. Application of Infection Control for the Prevention of COVID-19
2.4. Contact Limitation
2.5. Daily Monitoring of the Staff’s Health Conditions
2.6. Usage of ICT
2.7. Data Collection
2.8. Statistical Analysis
2.9. Ethics Approval
3. Results
3.1. Demographic Data
3.2. Patients’ Medical Care Visits to the Outpatient and Emergency Departments
3.3. Number of Days-Off Taken by the Staff
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Grabowski, D.C.; Stewart, K.A.; Broderick, S.M.; Coots, L.A. Predictors of Nursing Home Hospitalization: A Review of the Literature. Med. Care Res. Rev. 2008, 65, 3–39. [Google Scholar] [CrossRef] [PubMed]
- Cadenas, R.; Diez, M.J.; Fernández, N.; García, J.J.; Sahagún, A.M.; Sierra, M.; López, C.; Susperregui, J.; Díez, R. Prevalence and Associated Factors of Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2021, 18, 2037. [Google Scholar] [CrossRef] [PubMed]
- Davidson, P.M.; Szanton, S.L. Nursing Homes and COVID-19: We Can and Should Do Better. J. Clin. Nurs. 2020, 29, 2758–2759. [Google Scholar] [CrossRef] [Green Version]
- Ouslander, J.G.; Grabowski, D.C. COVID-19 in Nursing Homes: Calming the Perfect Storm. J. Am. Geriatr. Soc. 2020, 68, 2153–2162. [Google Scholar] [CrossRef] [PubMed]
- Huang, H.; Xie, Y.; Chen, Z.; Xiao, M.; Cao, S.; Mi, J.; Yu, X.; Zhao, Q. Nursing Home in the COVID-19 Outbreak: Challenge, Recovery, and Resiliency. J. Gerontol. Soc. Work 2020, 63, 646–650. [Google Scholar] [CrossRef] [PubMed]
- Werner, R.M.; Hoffman, A.K.; Coe, N.B. Long-Term Care Policy after Covid-19—Solving the Nursing Home Crisis. N. Engl. J. Med. 2020, 383, 903–905. [Google Scholar] [CrossRef] [PubMed]
- Ioannidis, J.P.A.; Axfors, C.; Contopoulos-Ioannidis, D.G. Second Versus First Wave of COVID-19 Deaths: Shifts in Age Distribution and in Nursing Home Fatalities. Environ. Res. 2021, 195, 110856. [Google Scholar] [CrossRef] [PubMed]
- Dosa, D.; Jump, R.L.P.; LaPlante, K.; Gravenstein, S. Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk. J. Am. Med. Dir. Assoc. 2020, 21, 569–571. [Google Scholar] [CrossRef] [PubMed]
- Tan, L.F.; Seetharaman, S. Preventing the Spread of COVID-19 to Nursing Homes: Experience from a Singapore Geriatric Centre. J. Am. Geriatr. Soc. 2020, 68, 942. [Google Scholar] [CrossRef]
- Wang, L.; Qi, N.; Zhou, Y.; Zhang, H. Prevention and Infection Control of COVID-19 in Nursing Homes: Experience from China. Age Ageing 2020, 49, 894–895. [Google Scholar] [CrossRef]
- Yen, M.Y.; Schwartz, J.; King, C.C.; Lee, C.M.; Hsueh, P.R. Society of Taiwan Long-term Care Infection Prevention and Control. Recommendations for Protecting Against and Mitigating the COVID-19 Pandemic in Long-Term Care Facilities. J. Microbiol. Immunol. Infect. 2020, 53, 447–453. [Google Scholar] [CrossRef]
- Levitt, A.F.; Ling, S.M. COVID-19 in the Long-Term Care Setting: The CMS Perspective. J. Am. Geriatr. Soc. 2020, 68, 1366–1369. [Google Scholar] [CrossRef]
- O’Neill, D.; Briggs, R.; Holmerová, I.; Samuelsson, O.; Gordon, A.L.; Martin, F.C. Special Interest Group in Long Term Care of the European Geriatric Medicine Society. COVID-19 Highlights the Need for Universal Adoption of Standards of Medical Care for Physicians in Nursing Homes in Europe. Eur. Geriatr. Med. 2020, 11, 645–650. [Google Scholar] [CrossRef]
- Grabowski, D.C.; Mor, V. Nursing Home Care in Crisis in the Wake of COVID-19. JAMA 2020, 324, 23–24. [Google Scholar] [CrossRef]
- Qaseem, A.; Etxeandia-Ikobaltzeta, I.; Yost, J.; Miller, M.C.; Abraham, G.M.; Obley, A.J.; Forciea, M.A.; Jokela, J.A.; Humphrey, L.L. Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points from the American College of Physicians (Version 1). Ann. Intern. Med. 2020, 173, 642–649. [Google Scholar] [CrossRef]
- Verbeek, H.; Gerritsen, D.L.; Backhaus, R.; de Boer, B.S.; Koopmans, R.T.C.M.; Hamers, J.P.H. Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study into First Experiences and Impact on Well-Being. J. Am. Med. Dir. Assoc. 2020, 21, 900–904. [Google Scholar] [CrossRef]
- Low, L.F.; Hinsliff-Smith, K.; Sinha, S.K.; Stall, N.M.; Verbeek, H.; Siette, J.; Dow, B.; Backhaus, R.; Devi, R.; Spilsbury, K.; et al. Safe Visiting Is Essential for Nursing Home Residents during the COVID-19 Pandemic: An International Perspective. J. Am. Med. Dir. Assoc. 2021, 22, 977–978. [Google Scholar] [CrossRef]
- Garfin, D.R. Technology as a Coping Tool during the Coronavirus disease 2019 (COVID-19) Pandemic: Implications and Recommendations. Stress Health 2020, 36, 555–559. [Google Scholar] [CrossRef]
- Jackson, D.; Anders, R.; Padula, W.V.; Daly, J.; Davidson, P.M. Vulnerability of Nurse and Physicians with COVID-19: Monitoring and Surveillance Needed. J. Clin. Nurs. 2020, 29, 3584–3587. [Google Scholar] [CrossRef]
- Escobar, D.J.; Lanzi, M.; Saberi, P.; Love, R.; Linkin, D.R.; Kelly, J.J.; Jhala, D.; Amorosa, V.; Hofmann, M.; Doyon, J.B. Mitigation of a Coronavirus Disease 2019 Outbreak in a Nursing Home Through Serial Testing of Residents and Staff. Clin. Infect. Dis. 2020, 72, e394–e396. [Google Scholar] [CrossRef]
- Ranscombe, P. Rural Areas at Risk during COVID-19 Pandemic. Lancet Infect. Dis. 2020, 20, 545. [Google Scholar] [CrossRef]
- Ohta, R.; Ryu, Y.; Kitayuguchi, J.; Gomi, T.; Katsube, T. Challenges and Solutions in the Continuity of Home Care for Rural Older People: A Thematic Analysis. Home Health Care Serv. Q. 2020, 39, 126–139. [Google Scholar] [CrossRef] [PubMed]
- White, E.M.; Wetle, T.F.; Reddy, A.; Baier, R.R. Front-Line Nursing Home Staff Experiences during the COVID-19 Pandemic. J. Am. Med. Dir. Assoc. 2021, 22, 199–203. [Google Scholar] [CrossRef] [PubMed]
- Sharma, S.; Cain, J.; Sakhuja, A.; Schaefer, G.; Krupica, T.; Sarwari, A. Guidance for Healthcare Providers Managing COVID-19 in Rural and Underserved Areas. J. Racial Ethn. Health Disparit. 2020, 7, 817–821. [Google Scholar] [CrossRef]
- Shin, J.H.; Renaut, R.A.; Reiser, M.; Lee, J.Y.; Tang, T.Y. Increasing Registered Nurse Hours per Resident Day for Improved Nursing Home Residents’ Outcomes Using a Longitudinal Study. Int. J. Environ. Res. Public Health 2021, 18, 402. [Google Scholar] [CrossRef]
- Martínez-López, J.Á.; Lázaro-Pérez, C.; Gómez-Galán, J. Burnout Among Direct-Care Workers in Nursing Homes During the COVID-19 Pandemic in Spain: A Preventive and Educational Focus for Sustainable Workplaces. Sustainability 2021, 13, 2782. [Google Scholar] [CrossRef]
- Ohta, R.; Ryu, Y.; Sato, M.; Maeno, T. ICT-Driven Improvement of Interprofessional Collaboration between a Rural Clinic and Nursing Home: A Mixed Method. J. Interprof. Educ. Pract. 2020, 21, 100380. [Google Scholar] [CrossRef]
- Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. J. Chronic Dis. 1987, 40, 373–383. [Google Scholar] [CrossRef]
- Kanda, Y. Investigation of the Freely Available Easy-to-Use Software “EZR” for Medical Statistics. Bone Marrow Transplant. 2013, 48, 452–458. [Google Scholar] [CrossRef] [Green Version]
- Gorges, R.J.; Konetzka, R.T. Staffing Levels and COVID-19 Cases and Outbreaks in US Nursing Homes. J. Am. Geriatr. Soc. 2020, 68, 2462–2466. [Google Scholar] [CrossRef]
- Abrams, H.R.; Loomer, L.; Gandhi, A.; Grabowski, D.C. Characteristics of US Nursing Homes with COVID-19 Cases. J. Am. Geriatr. Soc. 2020, 68, 1653–1656. [Google Scholar] [CrossRef]
- Castle, N.G.; Ferguson, J.C. What Is Nursing Home Quality and How Is It Measured? Gerontologist 2010, 50, 426–442. [Google Scholar] [CrossRef] [Green Version]
- Bolcato, M.; Trabucco Aurilio, M.; Di Mizio, G.; Piccioni, A.; Feola, A.; Bonsignore, A.; Tettamanti, C.; Ciliberti, R.; Rodriguez, D.; Aprile, A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. Int. J. Environ. Res. Public Health 2021, 18, 2484. [Google Scholar] [CrossRef]
- Ohta, R.; Ryu, Y. Improvement in Palliative Care Quality in Rural Nursing Homes through Information and Communication Technology-Driven Interprofessional Collaboration. Rural Remote Health 2021, 21, 6450. [Google Scholar]
- van Dyck, L.I.; Wilkins, K.M.; Ouellet, J.; Ouellet, G.M.; Conroy, M.L. Combating Heightened Social Isolation of Nursing Home Elders: The Telephone Outreach in the COVID-19 Outbreak Program. Am. J. Geriatr. Psychiatry 2020, 28, 989–992. [Google Scholar] [CrossRef]
- Ohta, R.; Yoshinori, R.; Sato, M.; Maeno, T. Challenges of Using ICT Regarding Acute Conditions in Rural Home Care: A Thematic Analysis. J. Interprof. Educ. Pract. 2020, 20, 100349. [Google Scholar] [CrossRef]
- Miller, V.J.; Fields, N.L.; Anderson, K.A.; Kusmaul, N.; Maxwell, C. Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19. J. Gerontol. B Psychol. Sci. Soc. Sci. 2021, 76, e219–e224. [Google Scholar] [CrossRef]
- Sarabia-Cobo, C.; Pérez, V.; de Lorena, P.; Hermosilla-Grijalbo, C.; Sáenz-Jalón, M.; Fernández-Rodríguez, A.; Alconero-Camarero, A.R. Experiences of Geriatric Nurses in Nursing Home Settings Across Four Countries in the Face of the COVID-19 Pandemic. J. Adv. Nurs. 2021, 77, 869–878. [Google Scholar] [CrossRef]
- McGilton, K.S.; Escrig-Pinol, A.; Gordon, A.; Chu, C.H.; Zúñiga, F.; Sanchez, M.G.; Boscart, V.; Meyer, J.; Corazzini, K.N.; Jacinto, A.F.; et al. Uncovering the Devaluation of Nursing Home Staff during COVID-19: Are We Fuelling the Next Health Care Crisis? J. Am. Med. Dir. Assoc. 2020, 21, 962–965. [Google Scholar] [CrossRef]
- Nguyen, L.H.; Drew, D.A.; Graham, M.S.; Joshi, A.D.; Guo, C.G.; Ma, W.; Mehta, R.S.; Warner, E.T.; Sikavi, D.R.; Lo, C.H.; et al. Risk of COVID-19 among Front-line Health-Care Workers and the General Community: A Prospective Cohort Study. Lancet Public Health 2020, 5, e475–e483. [Google Scholar] [CrossRef]
- Nioi, M.; Napoli, P.E.; Lobina, J.; Fossarello, M.; d’Aloja, E. COVID-19 and Italian healthcare workers from the initial sacrifice to the mRNA vaccine: Pandemic chrono-history, epidemiological data, ethical dilemmas, and future challenges. Front. Public Health 2020, 8, 591900. [Google Scholar] [CrossRef] [PubMed]
Group | |||
---|---|---|---|
Factor | Pre-COVID Control (2019−2020) | Post-COVID Control (2020−2021) | p Value |
Age, average (SD) | 88.92 (7.24) | 90.38 (6.08) | 0.288 |
Sex (%) | 11 (22.9) | 11 (22.9) | 1 |
Albumin, average (SD) | 3.46 (0.40) | 3.50 (0.40) | 0.559 |
eGFR, average (SD) | 77.11 (29.57) | 72.40 (30.54) | 0.445 |
Medicines, average (SD) | 5.79 (2.49) | 6.31 (2.75) | 0.334 |
Care level (%) | |||
4 | 9 (18.8) | 8 (16.7) | 1 |
5 | 39 (81.2) | 40 (83.3) | |
Previous admission (%) | 21 (43.8) | 29 (60.4) | 0.152 |
CCI | 6.42 (1.40) | 6.31 (1.19) | 0.638 |
Asthma (%) | 2 (4.2) | 1 (2.1) | 1 |
Brain hemorrhage (%) | 5 (10.4) | 4 (8.3) | 1 |
Brain infarction (%) | 13 (27.1) | 12 (25.0) | 1 |
Cancer (%) | 3 (6.2) | 2 (4.2) | 1 |
Connective tissue disease (%) | 0 (0.0) | 1 (2.1) | 1 |
COPD (%) | 1 (2.1) | 1 (2.1) | 1 |
Dementia (%) | 47 (97.9) | 47 (97.9) | 1 |
DM (%) | 10 (20.8) | 7 (14.6) | 0.594 |
Heart failure (%) | 13 (27.1) | 12 (25.0) | 1 |
Hemiplegia (%) | 2 (4.2) | 2 (4.2) | 1 |
Kidney diseases (%) | 8 (16.7) | 11 (22.9) | 0.609 |
Liver diseases (%) | 0 (0.0) | 1 (2.1) | 1 |
Myocardial infarction (%) | 7 (14.6) | 6 (12.5) | 1 |
Peptic ulcer (%) | 1 (2.1) | 1 (2.1) | 1 |
Pre-COVID (2019–2020) | Post-COVID (2020–2021) | |||||||
---|---|---|---|---|---|---|---|---|
OD | ED | OD/Patient | ED/Patient | OD | ED | OD/Patient | ED/Patient | |
April | 23 | 3 | 0.479 | 0.063 | 16 | 4 | 0.333 | 0.083 |
mMay | 32 | 4 | 0.667 | 0.083 | 9 | 3 | 0.188 | 0.063 |
June | 17 | 6 | 0.354 | 0.125 | 16 | 4 | 0.333 | 0.083 |
July | 19 | 7 | 0.396 | 0.146 | 10 | 9 | 0.208 | 0.188 |
August | 25 | 3 | 0.521 | 0.063 | 14 | 4 | 0.292 | 0.083 |
September | 26 | 4 | 0.542 | 0.083 | 28 | 8 | 0.583 | 0.167 |
October | 19 | 5 | 0.396 | 0.104 | 19 | 5 | 0.396 | 0.104 |
November | 14 | 12 | 0.292 | 0.250 | 22 | 2 | 0.458 | 0.042 |
December | 27 | 8 | 0.563 | 0.167 | 30 | 6 | 0.625 | 0.125 |
January | 17 | 5 | 0.354 | 0.104 | 19 | 4 | 0.396 | 0.083 |
February | 14 | 7 | 0.292 | 0.146 | 11 | 3 | 0.229 | 0.063 |
March | 28 | 2 | 0.583 | 0.042 | 16 | 10 | 0.333 | 0.208 |
Total | 261 | 66 | 5.438 | 1.375 | 210 | 62 | 4.375 | 1.29 |
Pre-COVID (2019–2020) | Post-COVID (2020–2021) | p-Value | |
---|---|---|---|
Outpatient department | |||
monthly, average (SD) | 21.75 (5.89) | 17.5 (6.61) | |
per patient, monthly, average (SD) | 0.45 (0.12) | 0.37 (0.14) | 0.111 |
Emergency department | |||
monthly, average (SD) | 5.50 (2.75) | 5.18 (2.55) | |
per patient, monthly, average (SD) | 0.115 (0.06) | 0.108 (0.05) | 0.761 |
Staff day off | |||
monthly, average (SD) | 6.58 (10.65) | 12.92 (16.17) | |
per staff, monthly, average (SD) | 0.13 (0.20) | 0.25 (0.31) | 0.269 |
Pre-COVID (2019–2020) | Post-COVID (2020–2021) | |||
---|---|---|---|---|
Days Off | Days Off/Staff | Days Off | Days Off/Staff | |
April | 0 | 0.00 | 0 | 0.00 |
May | 0 | 0.00 | 0 | 0.00 |
June | 15 | 0.29 | 0 | 0.00 |
July | 34 | 0.65 | 0 | 0.00 |
August | 4 | 0.08 | 26 | 0.50 |
September | 9 | 0.17 | 30 | 0.58 |
October | 0 | 0.00 | 26 | 0.50 |
November | 0 | 0.00 | 3 | 0.06 |
December | 17 | 0.33 | 0 | 0.00 |
January | 0 | 0.00 | 3 | 0.06 |
February | 0 | 0.00 | 20 | 0.38 |
March | 0 | 0.00 | 47 | 0.90 |
Total | 79 | 1.52 | 155 | 2.98 |
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Ohta, R.; Ryu, Y.; Sano, C. Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes. Int. J. Environ. Res. Public Health 2021, 18, 5805. https://doi.org/10.3390/ijerph18115805
Ohta R, Ryu Y, Sano C. Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes. International Journal of Environmental Research and Public Health. 2021; 18(11):5805. https://doi.org/10.3390/ijerph18115805
Chicago/Turabian StyleOhta, Ryuichi, Yoshinori Ryu, and Chiaki Sano. 2021. "Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes" International Journal of Environmental Research and Public Health 18, no. 11: 5805. https://doi.org/10.3390/ijerph18115805