COVID-19 testing in English care homes and implications for staff and residents

Author:

Micocci Massimo1,Gordon Adam L23,Allen A Joy4,Hicks Timothy45,Kierkegaard Patrick1,McLister Anna1,Walne Simon1,Hayward Gail6,Buckle Peter1

Affiliation:

1. NIHR London In Vitro Diagnostics Co-operative, London, UK

2. Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK

3. NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham UK

4. NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, UK

5. Newcastle upon Tyne Hospitals NHS Foundation Trust, UK

6. NIHR Community Healthcare MedTech and IVD CO-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK

Abstract

Abstract Introduction Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). Methods A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. Results Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. Conclusion Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.

Funder

National Institute for Health Research NIHR

Asthma UK and the British Lung Foundation

CONDOR study

NIHR London In Vitro Diagnostics Co-operative

NIHR Applied Research Collaboration-East Midlands

NIHR Newcastle In Vitro Diagnostics Co-operative

NIHR Community Healthcare MedTech and IVD Co-operative

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Ageing,General Medicine

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