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Pandemic response gaps: Infection prevention and control lessons learned during coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities in Detroit, Michigan

Published online by Cambridge University Press:  10 August 2022

Avnish Sandhu Open the ORCID record for Avnish Sandhu [Opens in a new window] ,
Jordan Micah F. Polistico ,
Monica P. Meyer ,
Gonzalo Gonzalez ,
Keith Kiama ,
Mark Lebednick ,
Tyler Prentiss ,
Helina Misikir ,
Jessica Heinonen  and
John Zervos
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Avnish Sandhu
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
Jordan Micah F. Polistico
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
Monica P. Meyer
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
Gonzalo Gonzalez
Affiliation:
Detroit Health Department, Detroit, Michigan
Keith Kiama
Affiliation:
Detroit Health Department, Detroit, Michigan
Mark Lebednick
Affiliation:
Detroit Health Department, Detroit, Michigan
Tyler Prentiss
Affiliation:
Henry Ford Health System, Detroit, Michigan
Helina Misikir
Affiliation:
Henry Ford Health System, Detroit, Michigan
Jessica Heinonen
Affiliation:
Henry Ford Health System, Detroit, Michigan
John Zervos
Affiliation:
Henry Ford Health System, Detroit, Michigan
Paul E. Kilgore
Affiliation:
Department of Pharmacy Practice, Wayne State University School of Medicine, Detroit, Michigan
Marcus J. Zervos
Affiliation:
Henry Ford Health System, Detroit, Michigan Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
Lauren R. Fink
Affiliation:
Oakland County Health Department, Pontiac, Michigan
Najibah K. Rehman
Affiliation:
Detroit Health Department, Detroit, Michigan
Catherine Maples
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
Teena Chopra*
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
*
Author for correspondence: Teena Chopra, E-mail: tchopra@med.wayne.edu
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Abstract

Background:

Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak.

Methods:

We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time.

Results:

Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2.

Conclusion:

On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 6 , June 2023 , pp. 915 - 919
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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