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BMC Infectious Diseases
Article . 2024 . Peer-reviewed
License: CC BY
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BMC Infectious Diseases
Article . 2024
Data sources: DOAJ
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How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections

Authors: Laura Arnold; Simon Bimczok; Hannah Schütt; Stefanie Lisak-Wahl; Barbara Buchberger; Jan M Stratil;

How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections

Abstract

Abstract Background The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long‐term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non‐pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear. Methods We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE. Results We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems. Conclusions Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics. Trial registration CRD42022344149.

Keywords

CERTAINTY, Nursing homes, SARS-COV-2, Infectious and parasitic diseases, RC109-216, Respiratory tract infections, NURSING-HOMES, STAFF MEMBERS, Humans, Respiratory Tract Infections, Pandemics, Randomized Controlled Trials as Topic, Infection Control, SARS-CoV-2, Research, Public health practice, COVID-19, Hygiene, Wirtschaftswissenschaften, Long-Term Care, Mandatory testing, Influenza, Physical distancing, COVID-19 ; Respiratory Tract Infections/prevention ; Infection Control/methods [MeSH] ; Pandemics/prevention ; Humans [MeSH] ; Long-Term Care [MeSH] ; Systematic Reviews on Infectious Diseases ; Public health practice ; Mandatory testing ; Pandemics ; Randomized Controlled Trials as Topic [MeSH] ; Respiratory Tract Infections/epidemiology [MeSH] ; Physical distancing ; COVID-19/prevention ; Research ; Influenza ; Respiratory tract infections ; Nursing homes ; Communicable disease control ; Respiratory Tract Infections/virology [MeSH] ; COVID-19/epidemiology [MeSH] ; SARS-CoV-2 [MeSH] ; Hygiene, COVID-19 OUTBREAKS, Communicable disease control, MENTAL-HEALTH, RESIDENTS, INTERVENTIONS

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    popularity
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    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
gold