EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | Shannon Edwards, MD | William L. Mason, MD | J. Gary Wheeler, MD, MPS | Beth Milligan, MD, FAAFP, CHCQM, CPE
Containing Disease Outbreaks in
Residential Care Settings
LAURA HOBART-PORTER, DO, FAAPMR
The Centers for Disease Control
and Prevention (CDC) estimates
that 1.5 million Americans
reside in long-term care
settings, such as nursing homes
or complex care facilities. 1 These
institutions are designed to deliver
specialized care including therapy,
recreation and medical support, to
those whose needs are too complex
to be met at home. Most residential
care settings are structured to
accommodate communal living,
including shared recreation, dining
spaces and group activities.
These arrangements can become
a liability if there is an infectious outbreak,
as communal care is ideally
suited for spreading an infectious
pathogen. Unique interventions
must be taken to keep residents and
staff safe. 2 In the adult long-term
care setting, infections tend to be
pneumonia, urinary tract infections
and wound infections. Children in
similar settings are more likely to
have upper respiratory or gastrointestinal
infections. 1
As with any infection-management
program, prevention is key.
Ideally, this should take place in
advance of an outbreak, in the form
of a disaster preparedness plan. All
members of a facility (including
medical staff and administration)
must work together, using the disaster
preparedness plan as a guide, to
assess and manage the outbreak.
A unified response ensures that
staffing, supplies and programming
can withstand changes related to
outbreak management.
Prevention, though ideal, cannot
always be achieved. Vaccines should
be utilized when they are available,
including enterovirus vaccines in
children and pneumococcal vaccines
in adults.
All staff, including non-clinical
staff, must receive education about
pathogen spread, how to prevent it
and training on the appropriate use
of personal protective equipment
(PPE). 3 Simple handwashing, when
applied strictly, can significantly
decrease the rate of infection within
residential settings.
Screening for staff or visitor illness
can help prevent outside pathogens
from reaching vulnerable residents.
Facilities should have policies in
place to allow for management of
staff and visitors’ health screenings.
Common areas such as recreation
and dining spaces should be
regularly and thoroughly cleaned.
Care should be taken to minimize
multiple persons touching the same
objects (toys, silverware, etc.). Hand
sanitizer must be readily available,
and staff and residents should be
encouraged to wash hands prior to
meals.
Early identification of an infectious
agent is essential to prevent
further spread. Recognition of infection
signs including fever, cough,
vomiting, diarrhea or rhinorrhea
should prompt rapid testing, as clinically
indicated. Before the availability
of respiratory polymerase chain
reaction (PCR), this was often not a
consideration, making it impossible
to tell the difference between
a relatively benign rhinovirus or a
potentially life-threatening human
metapneumovirus. 4 The availability
of these tools has enhanced the
ability to recognize and manage
infections.
Amid the coronavirus pandemic,
the need for rapid testing has been
made clear. Once a resident is identified
as being ill, he or she should
be immediately isolated from others.
This can be challenging in a communal
setting. If they are in a shared
living space, they should be moved
to an isolation room while awaiting
60 • The Journal of the Arkansas Medical Society www.ArkMed.org