@article{c69e91605ebd41b2bc130c4aa7f8ce2a,
title = "Facility- and ward-level factors associated with SARS-CoV-2 outbreaks among residents in long-term care facilities: A retrospective cohort study",
abstract = "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/ )",
keywords = "SARS-CoV-2, COVID-19, Long-term care, Nursing homes, Disease outbreaks, Risk factors",
author = "F. Houben and {den Heijer}, C.D.J. and N.H.T.M. Dukers-Muijrers and A.M.J. Daamen and N.S. Groeneveld and G.C.M. Vijgen and M.J.M. Martens and R.W.H. Heijnen and C.J.P.A. Hoebe",
note = "Funding Information: This research was funded by the Public Health Service South Limburg. The funders had no role in the design, collection, analysis, interpretation, and reporting of the study. The data were retrieved from regular infectious disease control activities, which fall under the tasks and responsibilities of the Public Health Service. The study protocol was exempt from formal medical ethical approval under the prevailing laws in the Netherlands because it concerns a retrospective observational study using facility-level data with no patient-level identifiers (i.e. anonymous data) (as stated by the National Central Committee for Human Studies: www.ccmo.nl and in the conduct of good behavior in research). As such, no additional administrative permissions were required to use the required data. The authors would like to thank the participating LTCFs in South Limburg for their close collaboration and involvement in the study. Also, the authors give special thanks to Merel Schreuders (research assistant) who assisted in data cleaning during the initial phases of the study. FH (ORCID 0000-0001-8611-4110), CDJH (ORCID 0000-0003-1476-4346), and CJPAH (ORCID 0000-0003-1815-0974) conceptualised and designed the study. AMJD, NSG, GCMV, MJMM, and RWHH collected the data. FH (ORCID 0000-0001-8611-4110) performed the data analysis, data interpretation, and drafts of the manuscript. CJPAH and NHTMD (ORCID 0000-0003-4896-758X) supervised the study. All authors contributed to manuscript editing and approved the final manuscript. The datasets used and analysed during the current study are available from the head of the data archiving of the Public Health Service South Limburg on reasonable request. Interested researchers should contact the head of the data archiving of the Public Health Service South Limburg (Helen Sijstermans: helen.sijstermans@ggdzl.nl) when they would like to reuse the data. Funding Information: This research was funded by the Public Health Service South Limburg . The funders had no role in the design, collection, analysis, interpretation, and reporting of the study. Publisher Copyright: {\textcopyright} 2023 The Author(s)",
year = "2023",
month = may,
day = "1",
doi = "10.1016/j.ijid.2023.03.007",
language = "English",
volume = "130",
pages = "166--175",
journal = "International Journal of Infectious Diseases",
issn = "1201-9712",
publisher = "ELSEVIER SCI LTD",
number = "1",
}