SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave
2. Materials and Methods
2.1. Study Setting
2.2. Questionnaire Investigation
2.3. ICAR Tool
2.4. Field Investigation
2.5. Statistical Analysis
3.1. Introductory Questionnaire Results
3.2. Field Assessment Results
3.2.1. Visit Restrictions and Non-Essential Personnel Restrictions
3.2.2. Education, Monitoring, and Screening of Healthcare Personnel (HCP)
3.2.3. Education, Monitoring, and Screening, and Cohorting of Residents
3.2.4. Availability of Personal Protective (PPE) Equipment and other Supplies
3.2.5. Infection Prevention and Control Practices
3.3. Risk Perception Versus Facilities Hazard Analysis
- Be first: crises are time sensitive. Communicating information quickly is crucial. For citizens, the first source of information often becomes the preferred source.
- Be right: accuracy establishes credibility. Information can include what is known, what is not known, and what is being done to fill in the gaps.
- Be credible: honesty and truthfulness should not be compromised during crises.
- Express empathy: crises create harm, and the suffering should be acknowledged in words. Addressing what people are feeling, and the challenges they face, builds trust and rapport.
- Promote action: giving people meaningful things to do calms anxiety, helps restore order, and promotes some sense of control.
- Show respect: respectful communication is particularly important when people feel vulnerable. Respectful communication promotes cooperation.
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Old-age index (%)||178.4||221.6||202.7||216.7||204.8||272.8||255.4|
|Average age of the population||45.7||47.3||46.6||47.1||46.7||48.8||48.3|
|Facilities’ Perception||Assessment of Facilities|
|(Items Extracted from Introductory Questionnaire)||(Items Extracted from the ICAR Checklist)|
|Body temperature is monitored for all staff before entering the facility||All HCP (including everyone in the facility staff) are screened at the beginning of their shift for fever and symptoms of COVID-19|
|At the entrance of the facility, alcohol-based hand rub (ABHR) is available for everyone||Potential visitors are screened prior to entry for fever or symptoms of COVID-19. Those with symptoms are not permitted to enter the facility|
|Anyone entering the facility wears a surgical mask for the entire length of stay||Visitors that are permitted inside must wear a cloth face covering while in the building and restrict their visit to the resident’s room or other location designated by the facility. They are also reminded to frequently perform hand hygiene|
|Body temperature is measured daily for all the residents of the facility||The facility assesses residents for fever and symptoms of COVID-19 upon admission and at least daily throughout their stay in the facility|
|A facility staff member has been identified to verify the correct use of PPE by health workers and proper hand hygiene||The facility monitors HCP adherence to recommended IPC practices|
|The ABHR is readily available to all healthcare staff during patient care activities||PPE is available in resident care areas including outside resident rooms|
|Newly admitted residents are housed in a dedicated room and avoid contact with other people during the observation period (14 days)||The facility has a plan for managing new admissions and readmissions whose COVID-19 status is unknown|
|Newly admitted residents are swabbed before entering the facility and at the end of the observation period (14 days)||The facility has dedicated a team of primary HCP staff to work only in this area of the facility|
|There is a procedure for rapid isolation of people with a new confirmed/suspected case of COVID-19 and the case is reported to the referring physician||The facility has a plan for how to deal with residents in the facility who develop COVID-19|
|Transfer of a COVID-19 confirmed/suspected case to another facility is expected if adequate isolation of the subject cannot be arranged||The facility has dedicated a space in which to care for residents with confirmed COVID-19.|
|A dedicated area of the facility has been identified and could be used in case of a high number of COVID-19 cases (cohort isolation)||Availability of beds in isolation facilities assessed at time of survey|
|Facility staff (including non-employees) are expressly informed not to attend work with fever, myalgia, asthenia or respiratory/gastrointestinal symptoms||The facility has provided education and refresher training to HCP (including consultant personnel) about the following: COVID-19|
|The facility staff has been informed to avoid close contact between colleagues, except for any resident care activity if necessary||The facility has provided education and refresher training to HCP (including consultant personnel) about the following: sick leave policies and the importance of not reporting to or remaining at work when sick|
|Caregivers are trained in the procedure to be taken when a new resident enters the facility (from hospital/household)||The facility has provided education and refresher training to HCP (including consultant personnel) about the following:|
new policies for source control while in the facility
|Facility staff are trained on the procedure to be adopted in case of a new confirmed/suspected COVID-19 host||The facility has provided staff with education on how to use a facemask or respirator if more than source control is required|
|Specific training was carried out||All HCP are reminded to practice social distancing when in break rooms and common areas|
|More than 50% of the facility staff has attended the specific training activities||If HCP are ill, they are instructed to keep their cloth face covering or facemask on and leave the facility. HCP with suspected or confirmed COVID-19 should notify their supervisor at any facility where they work|
|Age (Mean, SD)||81.0 (±11.0)||47.0 (±10.0)||69.4 (±19.5)|
|Lethality by group|
|80 to 89 years||21/80||26.3||0||0||21/80||26.3|
|70 to 79 years||4/28||14.3||0||0||4/28||14.3|
|60 to 69 years||2/12||16.7||0/10||0||2/22||9.1|
|Distribution of comorbidities|
|Chronic Respiratory diseases||18||26.5||3||42.9||21||28.0|
|Chronic neurological diseases||5||7.4||0||0||5||6.7|
|Obesity (BMI 30 to 40)||3||4.4||0||0||3||4.0|
|Information on the facility, residents and staff||Median||(Range)|
|Total number of beds||40||(15–163)|
|Total number of residential rooms||24.5||(12–117)|
|Total number of single residential rooms||9||(0–64)|
|Current number of resident guests||35.5||(10–104)|
|Number of beds predisposed for COVID-19 isolation||2||(0–9)|
|Number of COVID-19 cases are currently confirmed among residents||0||(0–0)|
|Number of beds set up for quarantine period and contact monitoring||1||(0–13)|
|Number of subjects who provide activities in the structure (employees and non-employees.)||17||(11–160)|
|Number of Nurses in the structure||2||(0–14)|
|Number of social and health workers employed in the structure||10||(1–70)|
|Number of COVID-19 cases currently confirmed among facility staff||0||(0–0)|
|Procedures performed by facilities||n||(%)|
|Fourteen-day observation period for new residents||12||(85.7%)|
|Nasopharyngeal swab performed at the beginning and at the end of the observation period||12||(85.7%)|
|Facility staff advised not to attend work if symptomatic||14||(100%)|
|Body temperature assessment before entering the facility||14||(100%)|
|All entrances of the facilities are provided with ABHR||14||(100%)|
|Use of surgical face mask for entire duration of stay (visitors)||14||(100%)|
|Instructions provided to facility staff on limiting contact if not needed for patient care||14||(100%)|
|Restrictions on visits by family members||14||(100%)|
|Daily body temperature measurement for all residents in the facility||13||(92.9%)|
|Staff informed on facility admission procedures for new residents||14||(100%)|
|Expected rapid isolation procedure of COVID-19 suspected/confirmed cases and reporting to the referring doctor||14||(100%)|
|Expected procedure for transferring COVID-19 suspected/confirmed cases in the impossibility of isolation||9||(64.3%)|
|Information provided to facility staff on the procedures to perform in the event of a suspected/confirmed case||14||(100%)|
|Dedicated space provided within the facilities for cohort isolation of COVID-19 cases||9||(64.3%)|
|Member of facility staff identified to verify the correct use of PPE by health workers and proper hand hygiene||12||(85.7%)|
|Alcohol-based hand rub readily available to all facility staff||14||(100%)|
|Periodic sanitation of facility staff rooms||14||(100%)|
|Facility has a person in charge for the control of consumption, purchases and stocks of PPE||14||(100%)|
|The cleaning staff is:|
|Part of the facility workforce||12||(85.8%)|
|Partly in the workforce and partly external to the facility||1||(7.1%)|
|Specific COVID-19 training carried out for staff (HCA, Nurses, etc):|
|Percentage of the staff who completed dedicated COVID-19 training.|
|Less than 25%||0||(0%)|
|25 to 50%||1||(10%)|
|51 to 75%||1||(10%)|
|1. Restrictions on visitors and non-essential personnel||n||(%)|
|Limitation of visits||14||(100%)|
|Exceptions assessed individually||7||(50%)|
|Visitor behavioral restrictions||12||(86%)|
|Suspension of non-essential services||14||(100%)|
|Communication of facility’s lockdown to family members||12||(86%)|
|Alternative methods to the visit||14||(100%)|
|Presence of information boards at entrances||3||(21%)|
|2. Education, Monitoring, and Screening of Healthcare Personnel (HCP)||n||(%)|
|Staff education: COVID-19||6||(43%)|
|Staff education: Sick leave||14||(100%)|
|Staff education: New infection control policies||10||(71%)|
|Monitoring: Hand Hygiene Audit||2||(14%)|
|Monitoring: PPE Selection and Use Audit||2||(14%)|
|Monitoring: Cleanliness and Disinfection Audit||2||(14%)|
|Staffing Needs and Shortage Plan||5||(36%)|
|Universal use of face masks||12||(86%)|
|Instruction given to facility staff on different types of masks||6||(43%)|
|Instruction given to facility staff on social distancing||11||(79%)|
|Staff screening at the beginning of the work shift||11||(79%)|
|Information on how to behave in case of symptoms while working in the facility||12||(86%)|
|Staff symptoms log||6||(43%)|
|3. Education, Monitoring, and Screening, and Cohorting of Residents||n||(%)|
|Information: informing facility staff of the onset of symptoms||13||(93%)|
|Information: protective actions to be implemented||14||(100%)|
|Information: protective actions implemented by the facility||14||(100%)|
|Daily monitoring of symptoms||10||(71%)|
|Application of precautions to suspected COVID-19 cases||13||(93%)|
|Symptomatic resident log||10||(71%)|
|Interruption of community activities||5||(36%)|
|Interruption of communal catering||4||(29%)|
|Additional actions in emergency: movements restriction||4||(29%)|
|Additional actions in emergency: movements not restricted but precautions to be taken||6||(43%)|
|Monitoring sick residents three times a day||12||(86%)|
|Dedicated COVID-19 area||10||(71%)|
|Dedicated COVID-19 team||2||(14%)|
|COVID-19 patient management plan||9||(64%)|
|New admission/readmission management plan||8||(57%)|
|Use of recommended PPE in COVID-19 areas or facility-wide if high number of cases||12||(86%)|
|4. Availability of Personal Protective (PPE) Equipment and other Supplies||n||(%)|
|PPE supply assessment||10||(71%)|
|Involvement of the Prevention Department for PPE shortages||5||(36%)|
|PPE supply optimisation measures||7||(50%)|
|PPE near to the patient care areas||0||(0%)|
|Availability of virucidal disinfectants||14||(100%)|
|Wipes/bins available for respiratory hygiene in shared spaces||5||(36%)|
|5. Infection Prevention and Control Practices||n||(%)|
|Hand hygiene: before resident contact, even if gloves will be worn||12||(86%)|
|Hand hygiene: after contact with the resident||9||(64%)|
|Hand hygiene: after contact with blood, body fluids, or contaminated surfaces or equipment||10||(71%)|
|Hand hygiene: before performing an aseptic task||6||(43%)|
|Hand hygiene: after removing PPE||11||(79%)|
|Facility favors use of ABHR||4||(29%)|
|PPE used in suspected/confirmed cases: gloves||14||(100%)|
|PPE used in suspected/confirmed cases: coveralls||13||(93%)|
|PPE used in suspected/confirmed cases: FFP2/FFP3||12||(86%)|
|PPE used for suspected/confirmed cases: eye protection||12||(86%)|
|Proper PPE removal and subsequent hand hygiene||11||(79%)|
|Hand hygiene supply available in care areas||7||(50%)|
|Monitoring: hand hygiene adherence and correct use of PPE||2||(14%)|
|Disinfection of shared patient care equipment||11||(79%)|
|Suitability of disinfectants for environmental cleaning||14||(100%)|
|Knowledge of contact times of disinfectants||4||(29%)|
|Use of disinfectant according to label instructions||13||(93%)|
|Public Health Communication: single case suspected or confirmed||13||(93%)|
|Public Health Communication: worsening of respiratory symptoms||14||(100%)|
|Public Health Communication: multiple cases of respiratory symptoms||12||(86%)|
|Procedures for informing family members and staff about suspected/confirmed cases||13||(93%)|
|Procedures for informing about suspected/confirmed cases during intake from external services.||9||(64%)|
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Gugliotta, C.; Gentili, D.; Marras, S.; Dettori, M.; Muglia, P.P.; Desole, M.G.; Acciaro, M.; Bellu, S.; Azara, A.; Castiglia, P. SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave. Int. J. Environ. Res. Public Health 2021, 18, 5712. https://doi.org/10.3390/ijerph18115712
Gugliotta C, Gentili D, Marras S, Dettori M, Muglia PP, Desole MG, Acciaro M, Bellu S, Azara A, Castiglia P. SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave. International Journal of Environmental Research and Public Health. 2021; 18(11):5712. https://doi.org/10.3390/ijerph18115712Chicago/Turabian Style
Gugliotta, Carmelo, Davide Gentili, Silvia Marras, Marco Dettori, Pietro Paolo Muglia, Maria Giuseppina Desole, Marcello Acciaro, Sabina Bellu, Antonio Azara, and Paolo Castiglia. 2021. "SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave" International Journal of Environmental Research and Public Health 18, no. 11: 5712. https://doi.org/10.3390/ijerph18115712