Chief medical officers must work hand-in-hand with their local referral hospitals and laboratories to successfully manage COVID-19 outbreaks in nursing facilities, according to a new study.

Investigators examined COVID-19 infection control efforts in three Southeast Michigan facilities affiliated with a large academic healthcare system. All 215 residents participated. The researchers examined outbreak identification, universal testing, point prevalence of COVID‐19, and subsequent containment efforts, outcomes, and challenges. 

Immediately upon detection of confirmed cases in March and April, each nursing home worked with local stakeholders to implement facility‐wide testing and the following interventions: 

  • Cohorting of COVID‐19 positive residents
  • Communication regarding testing and results with residents, healthcare professionals, and families
  • Personal protective equipment re‐education and use throughout facilities
  • Dedicated staffing for infected patients cohorted in a dedicated COVID‐19 wing

The researchers collected patient data, including 14‐day outcomes. A total of 29 cases were identified. Symptom‐triggered testing in March and April caught 19 of these cases. The others were identified through universal testing. 

The hospitalization rate was 38%. The case fatality rate was 21% at the end of June (these residents also had multiple comorbidities). No resident who tested positive through the point‐prevalence survey required hospitalization, and four were discharged home within two weeks.

The involvement of the local hospital, public health officials and the parent corporation was crucial to containing the outbreaks, wrote Ana Montoya M.D., MPH, of the University of Michigan Medical School, and colleagues.

“Proactive and coordinated steps are needed between nursing home medical directors and administrators, referral hospitals and their laboratories to save lives, minimize the burden to the healthcare system, and save healthcare costs,” they concluded.

The study was published Friday in the Journal of the American Geriatrics Society.