Table 2 Included studies from the outbreak setting
Author | Design | Setting | Pathogen or disease | Sample size | Topic | N of cases | Overall attack rate | Outbreak Date | Control measures | Results | Mean quality score |
|---|---|---|---|---|---|---|---|---|---|---|---|
Ahmed et al. (2018) [47] | Case–control study | 1 LTCF in the USA | GAS | 228-bed skilled nursing facility | IPC bundle | 7 residents and 5 staff | 0.84% resident: 0.65% Staff: 1.41% | 05/2014–08/2016 | Active surveillance, contact precaution, recommendation for use of PPE during irrigation, changing soiled diapers/linen before dressing change, and adopting a supportive sick leave policy | Frequent antimicrobial treatment and wound vacuum-assisted closure devices as risk factors | Medium |
Al Hamad et al. (2021) [48] | Outbreak report | 1 LTCF in Qatar | Covid-19 | Not reported | IPC bundle | 24 cases | Not reported | 06/2020 | Education, awareness, staff compliance monitoring, contact tracing, visitor policy revision, monitoring | Lapse of infection control practices, successful containment of the outbreak, only 57% of patients were symptomatic | Low |
Barret et al. (2014) [49] | Outbreak report | 1040 LTCFs in France | Gastroenteritis (Norovirus 73%, Rotavirus 19%) | Residents and staff | IPC bundle | 26.551 episodes among resident, 5.548 episodes among staff | resident: 32.5% Staff: 12.40% | 05/2010–05/2012 | Reinforcement of hand hygiene, contact precautions, cleaning or disinfection of the environment, restriction of movements, stopping or limitation of group activities, measures on food handling | The attack rate was lower and the duration of outbreaks was shorter when infection control measures were implemented within three days of onset of the first case | Low |
Bernadou et al. (2021) [50] | Outbreak report | 1 NH France | Covid-19 | 88 residents, 104 staff | IPC bundle | 109 cases | 55% | 03–05/2020 | Mass testing, symptom screening, active surveillance, droplet measures | Significant rate of asymptomatic residents detected through mass screening | Low |
Bruins et al. (2020) [51] | Outbreak report | 1 NH in the Netherlands | MDRO | 110 residents | IPC bundle | 8 cases | 7% | 02/2017–05/2018 | Screening, contact precautions, intensive cleaning procedure, education | Spread was associated with the use of shared toilets in communal areas. Containment of the outbreak after the implementation of a customized IPC bundle | Low |
Calles et al. (2017) [52] | Case–control study | 1 LTCF in the USA | Hepatitis C | 114-bed skilled nursing facility | IPC bundle | All cases: 45 residents, case–control: 30 cases/ 62 controls | Overall: 10.54%, Residents:15.63% Staff: 0% | 01/2011–09/2013 | Screening, environmental measures, use of single-use of instruments, cleaning and disinfection, glove change, | Podiatry care and INR monitoring by phlebotomy were significantly associated with HCV cases | Medium |
Dom´ınguez- Berjo´n et al. (2007) [53] | Cohort study | 1 NH in Spain | Adenovirus | 118 residents | IPC bundle | 46 cases (36 residents and 10 HCWs)/193 controls | Overall: 19.25%, Resident: 30.51% Staff: 8.26% | 08–12/2005 | Cleaning and disinfection, hand hygiene, isolation, withdrawal of affected workers, admission stop, visitor restrictions, education | Age, nursing home floor and cognitive impairment as independent risk factors | Medium |
Dooling et al. (2013) [54] | Case–control study | 1 LTCF in the USA | GAS | Not reported | IPC bundle | Total: 19 residents with 24 infections Case- control study: 18 infections/54 controls | Not reported | 06/2009–06/2012 | Carriage survey, contact precaution, education, and placement of additional alcohol-based hand rub dispensers, cleaning and disinfection, chemoprophylaxis | Indwelling line and area of living as independent risk factors | Medium |
Gaillat et al. (2008) [55] | Outbreak report | 1 NH in France | ILI (Influenza A) | 81 residents | IPC bundle | 32 residents and 6 staff | Overall 29.46%, Residents: 39.51% Staff: 12.50% | 06–07/2005 | Isolation, wearing of surgical masks, droplet and contact precaution, chemoprophylaxis, setting up a crisis management team | This outbreak occurred in summer Spread of the virus because of close area of living | Low |
Hand et al. (2018) [56] | Outbreak report | 1 LTCF in the USA | Coronavirus NL63 | 130 residents | IPC bundle | 20 cases | 26% | 11/2017 | Standard and droplet precaution, hand hygiene, enhanced environmental cleaning | Outbreak report with Coronavirus NL63 | Low |
Kanayama et al. (2016) [57] | Case–control study | 1 LTCF in Japan | MRPA | Residents in a 225-bed LTCF | IPC bundle | Total: 23 cases Case- control study: 14 cases/28 controls | Not reported | 01/2013–01/2014 | Surveillance, infection control team composition, contact precautions, cohorting and using new gloves and gown, admission restriction, training and re-education of HCWs, deep environmental cleaning, discontinuation of sharing devices | Use of an oxygen mask and use of a nasogastric tube were significant factors associated with MRPA infection | Low |
Mahmud et al. (2013) [58] | Multiple outbreak reports | 37 LTCFs in Canada | Influenza A (47%), Influenza B (5%), Parainfluenza (5%), Respiratory syncytial virus (3%), not identified (40%) | Residents and staff in 37 LTCFs | IPC bundle | 154 outbreaks | Median (Influenza A and B) residents: 7.2%, staff: 3.3% | Median: 18 days (3–53 days) | Chemoprophylaxis: 57% of influenza A, 63% of influenza B (the other measures were not reported), early notification | Early notification to public health authorities was associated with lower attack rate and mortality rates among residents, Chemoprophylaxis was the measure associated with lower attack rates, but not with shorter duration of outbreaks or with lower mortality | Low |
McMichael et al. (2020) [59] | Outbreak report | 1 LTCF in the USA | COVID-19 | 130 residents and 170 staff | IPC bundle | 167 cases (101 residents, 50 HCW, 16 visitors) | Residents: 77.6% HCW: 29.4% | 02–03/2020 | Case investigation, contact tracing, quarantine of exposed persons, isolation, on-site enhancement of IPC measures | Outbreak description of one of the first COVID-19 outbreaks in a LTCF | Low |
Murti et al. (2021) [60] | Outbreak report | 1 NH in Canada | COVID-19 | 65 residents | IPC bundle | Residents: 61, Staff: 34 | Residents: Attack rate 94%, case fatality rate 45%; Staff: Attack rate 51% | 03–05/2020 | Droplet and contact precautions, universal masking of staff, testing, visitor restrictions | Tight clustering of cases with high attack rate of 94%, Outbreak containment after IPC implementation | Low |
Nanduri et al. (2019) [61] | Outbreak report | 1 LTCF in the USA | GAS | Not reported | IPC bundle | 19 invasive and 60 non-invasive cases (50 residents and 24 staff) | Not reported | 05/2014–08/2016 | Chemoprophylaxis, active surveillance, recommendation of health authority | Inadequate infection control and wound-care practices may lead to this prolonged GAS outbreak in a skilled nursing facility | Low |
Nicolay et al. (2018) [62] | Outbreak report | 1 NH in France | Acute gastroenteritis (Norovirus) | Nursing home with 89 residents | IPC bundle | 29 residents and 9 staff | 43.94% Resident: 57.65% Staff: 19.15% | 09–10/2016 | Reinforcement of standard precaution, barrier measures, limitation of the movements of symptomatic residents, environmental disinfection, stopping group activities, closure of the kitchen and outsourcing of meals | More dependent residents were at higher risk of acute gastroenteritis | Low |
Psevdos et al. (2021) [63] | Outbreak report | 1 NH in the USA | COVID-19 | 80 residents | IPC bundle | 25 residents | Attack rate 31%, mortality rate 24% | 03–04/2020 | Testing, visitor restrictions, symptom screening, admission stop, hand hygiene, masks, isolation, | Attack rate only 31%. Quick containment of the outbreak through IP measures | Low |
Sáez-López et al. (2019) [64] | Outbreak report | 1 LTCF in Portugal | Norovirus | 335 residents | IPC bundle | 146 people, 97 residents and 49 staff | Residents: 29%, Nurses: 19% | 10–12/2017 | Disinfection, hand hygiene, education, PPE, isolation and cohorting | Insufficient adherence to IPC measures due to staffing shortage | Low |
Shrader et al. (2021) [65] | Outbreak report | 1 LTCF in USA | COVID-19 | 98 residents, 156 staff | IPC bundle | 52 residents and 19 staff | Resident 52% | 03–08/2020 | Testing, PPE, disinfection and isolation, restriction of visitors | Outbreak controlled with IPC measures | Low |
Telford et al. (2021) [66] | Observational study | 24 LTCF in the USA | COVID-19 | 2580 LTCF residents | IPC bundle | 1004 | 39% | 06–07/2020 | Adherence to IPC (HH, Disinfection, Social Distancing, PPE, Symptom screening) | Implementation lowest in Disinfection, highest in symptoms screening, differences in social distancing and PPE between high-prevalence and low-prevalence group | Medium |
Thigpen et al. (2007) [67] | Outbreak report | 1 NH in the USA | GAS | Residents in a 146-bed nursing home | IPC bundle | Definite case: 6 residents Possible case: 4 residents | 6.9% | 11–12/2003 | Screening, reinforce standard precautions, improve access to hand disinfectants, to implement appropriate respiratory etiquette, influenza immunization, Chemoprophylaxis for colonized persons | Three risk factors for GAS: presence of congestive heart failure or history of myocardial infarction, residence on unit 2, and requiring a bed bath | Low |
Van Dort et al. (2007) [68] | Case–control study | 1 NH in the USA | NTHi | 120-bed nursing home | IPC bundle | 13 cases 18 controls | Not reported | 06–07/2005 | Universal precaution, respiratory droplet precaution, evaluating staffs with symptoms, throat culture survey for residents | None of the variables showed a significant association with NTHi | Medium |
Van Esch et al. (2015) [69] | Case control study, Outbreak report | 1 LTCF in Belgium | CDI | 120 bed LTCF | IPC bundle | 66 cases 61 controls | 51.97% | 01/2009–12/2012 | Stringent hygienic protocol, active surveillance, strict isolation, timely treatment for CDI (AB-prescription), cleaning and disinfection of residents rooms | The nutritional status was found to be significantly poorer in the residents with CDI | Low |
Weterings et al. (2015) [70] | Outbreak report | 1 hospital and 1 NH in the Netherlands | KPC-KP | 150-bed nursing home | IPC bundle | 4 cases | Not reported | 07–12/2013 | Isolation, PPE, Handrub with 70% alcohol, frequent audits of hand hygiene and direct feedback, daily cleaning of room and disinfection, contact screening surveillance | Preventing transmission of MDROs is challenging in nursing homes | Low |
Kennelly et al. (2021) [71] | Observational study | 45 NH in Ireland | COVID-19 | 2043 residents | Surveillance | 1741 cases | 43.9%, 27.2% asymptomatic, fatality rate 27.6% | 04–05/2020 | Surveillance | Significant impact of Covid-19 with high rate of asymptomatic carriers | Low |
Blackman et al. (2020) [72] | Outbreak report | 1 NH in the USA | COVID-19 | 150 bed institution | Testing | 32 symptomatic residents, 26 HCW, limited testing capacity | Not reported | Not reported | Education, personal protective equipment, masks, symptom screening, contact and droplet precautions | Severe outbreak despite IPC measures because of insufficient testing availability | Low |
Dora et al. (2020) [73] | Outbreak report | 1 NH in the USA | COVID-19 | 99 residents | Testing | Residents:19 Staff: 8 | Residents: 19%; Staff 6% | 03–04/2020 | Screening, droplet and contact precautions, visitor restrictions | Successful outbreak containment | Low |
Eckardt et al. (2020) [74] | Outbreak report | 1 LTCF in the USA | COVID-19 | 120 bed LTCF | Testing | Not reported | 5.4%, 3.6% and 0.41% in three point prevalence testing rounds every 14Â days | Not reported | Point prevalence testing | Containment of outbreak | Low |
Graham et al. (2020) [75] | Outbreak report | 4 NH in the UK | COVID-19 | 394 residents and 70 staff | Testing | Residents: 126 Staff: 3 | 40% with 43% asymptomatic, 26% mortality | 03–05/2020 | Two point prevalence surveys | 60% of SARS-CoV-2 positive residents were either asymptomatic or only had atypical symptoms for Covid-19 | Low |
Louie et al. (2021) [76] | Outbreak report | 4 LTCF in the USA | COVID-19 | 431 persons | Testing | 214 | 49.7%; thereof 40.2% asymptomatic | 03–04/2020 | Surveillance | Mass testing identified a high proportion of asymptomatic infections | Low |
Patel et al. (2020) [77] | Cohort study | 1 LTCF in the USA | COVID-19 | 127 residents | Testing | 33 thereof 13 asymptomatic | 26% | Not reported | Surveillance | High rate of asymptomatic infections | Medium |
Roxby et al. (2020) [78] | Outbreak report | 1 LTCF in the USA | COVID-19 | 80 residents and 62 HCW | Testing | 3 residents, 2 staff | 3.8% of residents, 3.2% of staff | Not reported | Mass testing, symptom screening | Detection of asymptomatic infected residents | Low |
Sacco et al. (2020) [79] | Outbreak report | 1 LTCF in France | COVID-19 | 87 residents and 92 staff members | Testing | 41 residents and 22 staff members | 47% in residents and 24% in staff | 03–04/2020 | Mass testing | High rate of asymptomatic infected persons | Low |
Sanchez et al. (2020) [80] | Outbreak report | 26 LTCF in the USA | COVID-19 | 2773 residents | Testing | 1207 cases | 44% | 03–05/2020 | Mass testing (two point-prevalence surveys) | 44% attack rate, 37% hospitalization, 24% mortality; Reduction of positivity after second point prevalence survey | Low |
Zollner et al. (2021) [81] | Outbreak report | 3 LTCF in Austria | COVID-19 | 277 residents | Testing | 36 | 13% | 03–04/2020 | Testing | Only 25% with fever and 19% with cough, 6/36 remained asymptomatic, hospitalization rate 58% and mortality rate 33%,19/214 HCW positive | Low |
Giddings et al. (2021) [82] | Cohort study | 330 LTCF in UK | COVID-19 | Resident and staffs | Vaccination | 297 outbreaks across all four time periods | 90% of LTCF | Not reported | Vaccination | Reduction of number of the proportion of LTCF with outbreaks over the four time periods from 51.5% to 4.7% | Medium |
Martinot et al. (2021) [83] | Outbreak report | 1 LTCF in France | COVID-19 | 93 residents | Vaccination | 40 cases (residents 24, HCW 16) | Residents 25.8%, HCW 21.9% | 03–05/2021 | Vaccination | Outbreak with alpha-variant,higher case rate in unvaccinated than in vaccinated residents, no severe symptoms in vaccinated residents | Low |
Mazagatos et al. (2021) [84] | Outbreak report | LTCFs in Spain | COVID-19 | Not reported | Vaccination | Not reported | Not reported | 12/2020–04/2021 | Vaccination | Effectiveness of 71%, 88% and 97% for infections, hospitalization and death | Low |
Van Ewijk et al. (2022) [85] | Outbreak report | 1 LTCF in the Netherlands | COVID-19 | 105 residents | Vaccination | 70 residents | 67% (70/105) | 11/2021–01/2022 | Booster vaccine dose | Booster vaccine curbed transmission | Low |
Cheng H-Y et al. (2018) [86] | Outbreak report | LTCFs in Taiwan | Influenza | 102 Outbreaks | Vaccination, antiviral treatment/prophylaxis | Median residents 65.5 | Median attack rate 24% | 2008–2014 | Antiviral prophylaxis | Initiating antiviral treatment within 2 days of outbreak start decreased the possibility of a large influenza outbreak to only one-third | Low |