Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study
Lucia Cazzoletti, Maria Zanolin, Ilaria Tocco Tussardi, Mulubirhan Assefa Alemayohu, Ernesto Zanetel, Donatella Visentin, Luca Fabbri, Massimo Giordani, Giancarlo Ruscitti, Pier Paolo Benetollo, Stefano Tardivo, Emanuele Torri
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. METHODS: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann-Whitney U test, Kruskal-Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and "being a COVID-19 case" as the dependent variable. RESULTS: = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45.2% median cumulative incidence). CONCLUSIONS: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them.