The Effect of Early Implementation of Infection Prevention and Control Outbreak Management Interventions on the Outbreak Duration, Attack Rate, Morbidity, and Mortality of Long-Term Care Residents During the COVID-19 Pandemic
- UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
- Christopher Carman (Creator)
- Institution
- The University of North Carolina at Greensboro (UNCG )
- Web Site: http://library.uncg.edu/
- Advisor
- Lori Lupe
Abstract: BACKGROUND/OBJECTIVE: Long-Term Care Facilities (LTCFs) all around the world were highly susceptible to disproportionate adverse patient outcomes during the COVID-19 pandemic, accounting for over 78% of total deaths in the United States. This project aims to answer if the LTCFs created the tragic results of the COVID-19 pandemic due to an absent state of preparedness, a lack of resources, and a deficient understanding of the importance of early implementation of critical Infection Prevention and Control (IPC) interventions. This project will determine the efficacy of timely implementation of IPC outbreak management interventions and their effect on patient outcomes.DESIGN AND SETTING: This study utilized a quantitative design to evaluate four measures of two separate SARS-CoV-2 (COVID-19) outbreaks to investigate the effect of early implementation of multiple infection prevention and control (IPC) outbreak management interventions. The four measures consisted of the length of the outbreak in days, the transmission rate of the virus, the increased morbidity, and mortality rates during each outbreak. The Iowa Evidenced-based practice model was employed for this project. This method assisted with identifying the practice gaps of the LTCFs’ contributing to late or non-implementation of outbreak management strategies. The inclusion criteria included any resident admitted to the LTCFs during the initial confirmed COVID-19-positive case through the outbreak resolution. There were no exclusion criteria utilized with this study population. Two LTCFs (Facility “A” & Facility “B”) with COVID-19 outbreaks occurring during the initial pandemic year of 2020 provided similar healthcare environmental settings and were chosen for this project. Both facilities are in the Piedmont region of North Carolina.PARTICIPANTS: The census at the time of the outbreak was utilized, consisting of 168 residents, 82 from Facility “A” and 86 from Facility “B.” The two facility outbreaks wereselected due to similarities of the populations in Age, Gender, Race & Ethnicity and the presence of comorbidity illnesses. (Refer to Table 3 for the data).MEASUREMENTS: Four outcome measurements were analyzed, including outbreak duration, attack rate (rate of transmission of disease among a set population), morbidity rate, and mortality rate. The analysis was derived from the utilization of on-site tri-weekly observations during the outbreaks, which were documented within the epidemiological investigations and retrospective chart reviews. This project utilized a literature research analysis component to assist in determining the ten (10) most “essential” IPC interventions, and the measurement focused on each LTCF’s date of full implementation of each intervention. For the purposes of this project, full implementation is defined as no deficiencies or non-compliance observed during the tri-weekly rounds on two consecutive rounds and then total compliance with the intervention on subsequent observational rounds.RESULTS: Facility “A” implemented the ten interventions later, specifically, days thirteen (13), fifteen (15), eighteen (18), twenty-five (25), forty (40), and fifty-five (55), as seen in Table 4.This late implementation significantly affected the four measures, as seen in Table 2. Facility “B” implemented the interventions on day one (1), as seen in Table 5, and had significantly lower adverse patient-outcome rates. Facility “A” had a twenty-six percent (26%) higher attack rate, a twelve percent (12%) higher morbidity rate, and a sixteen percent (16%) increased death rate.CONCLUSIONS: The LTCF that implemented the ten “essential” IPC outbreak management interventions on day one of the outbreak significantly reduced the attack rate, mortality, morbidity, and duration of the outbreak. This evidence suggests that adequately prepared facilities that implement IPC outbreak management strategies early will decrease transmission of COVID-19 and, therefore, improve patient outcomes during an outbreak situation.
The Effect of Early Implementation of Infection Prevention and Control Outbreak Management Interventions on the Outbreak Duration, Attack Rate, Morbidity, and Mortality of Long-Term Care Residents During the COVID-19 Pandemic
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Created on 1/11/2024
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Additional Information
- Publication
- Other
- Language: English
- Date: 2023
- Keywords
- COVID-19, Outbreak Management, Long-Term Care Facilities, Infection Prevention and Control Principles