Community Coronavirus Disease 2019 Activity Level and Nursing Home Staff Testing for Active Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Indiana

被引：4

作者：

Blackburn, Justin ^{[1
]}

Weaver, Lindsay ^{[2
]}

Cohen, Liza ^{[3
]}

Menachemi, Nir ^{[1
]}

Rusyniak, Daniel E. ^{[4
]}

Unroe, Kathleen T. ^{[3
,5
]}

机构：

[1] Indiana Univ, Dept Hlth Policy & Management, Richard M Fairbanks Sch Publ Hlth Indianapolis, Indianapolis, IN 46202 USA

[2] Indiana Dept Hlth, Indianapolis, IN USA

[3] Indiana Univ, Regenstrief Inst Inc, Ctr Aging Res, Indianapolis, IN USA

[4] Indiana Family & Social Serv Adm, Indianapolis, IN USA

[5] Indiana Univ Sch Med, Div Gen Internal Med & Geriatr, Indianapolis, IN 46202 USA

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2021年 / 22卷 / 01期

关键词：

Nursing facility; COVID-19; SARS-CoV-2; testing;

D O I：

10.1016/j.jamda.2020.10.038

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objectives: To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: Cross-sectional study. Setting and Participants: In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana. Measures: Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000. Results: The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601-0.696) and 0.649 (95% confidence interval 0.601-0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases. Conclusions and Implications: We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity. (C) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：204 / +

页数：6

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