Facility- and ward-level factors associated with SARS-CoV-2 outbreaks among residents in long-term care facilities: A retrospective cohort study

F. Houben*, C.D.J. den Heijer, N.H.T.M. Dukers-Muijrers, A.M.J. Daamen, N.S. Groeneveld, G.C.M. Vijgen, M.J.M. Martens, R.W.H. Heijnen, C.J.P.A. Hoebe

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19. Yet, the reasons why certain LTCFs are affected more by outbreaks are poorly understood. This study aimed to identify the facility-and ward-level factors associated with SARS-CoV-2 outbreaks among LTCF residents. Methods: We conducted a retrospective cohort study of multiple Dutch LTCFs (N = 60; with 298 wards providing care for similar to 5600 residents) from September 2020 to June 2021. A dataset was constructed linking SARS-CoV-2 cases among LTCF residents to facility-and ward-level factors. Multilevel logistic regression analyses examined the associations between these factors and the likelihood of a SARS-CoV-2 outbreak among residents.Results: During periods of the Classic variant, the mechanical recirculation of air was associated with significantly increased odds of a SARS-CoV-2 outbreak. During periods of the Alpha variant, the factors associated with significantly increased odds included large ward size ( >= 21 beds), wards providing psy-chogeriatric care, fewer restrictions on staff movement between wards and facilities, and a greater num-ber of cases among staff ( > 10 cases).Conclusion: Policy and protocols on reducing resident density, staff movement, and mechanical recircu-lation of air in buildings are recommended to enhance outbreak preparedness in LTCFs. The implemen- tation of low-threshold preventive measures among psychogeriatric residents is important because they appear as a particularly vulnerable group.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
Original languageEnglish
Pages (from-to)166-175
Number of pages10
JournalInternational Journal of Infectious Diseases
Publication statusPublished - 1 May 2023


  • SARS-CoV-2
  • COVID-19
  • Long-term care
  • Nursing homes
  • Disease outbreaks
  • Risk factors

Cite this