Structural and Managerial Risk Factors for COVID-19 Occurrence in French Nursing Homes

• Published in: International journal of health policy and management Vol. 11; no. 11; pp. 2630 - 2637
• Main Authors: Corvol, Aline, Charras, Kevin, Prud'homm, Joaquim, Lemoine, Fabien, Ory, Fabien, Viel, Jean François, Somme, Dominique
• Format: Journal Article
• Language: English
• Published: Iran Kerman University of Medical Sciences 01-11-2022
• Subjects: Bioengineering; communal dining; Coronaviruses; COVID-19; Epidemiology; france; Health aspects; Life Sciences; lockdown; nursing home; Nursing homes; Original; personal protective equipment; France; COVID-19; Communal Dining; Personal Protective Equipment; Lockdown; France; Nursing Home
• ISSN: 2322-5939; 2322-5939
• DOI: 10.34172/ijhpm.2022.6741

Nursing home (NH) residents accounted for half of the deaths during the 2020 spring wave of the coronavirus disease 2019 (COVID-19) epidemic in France. Our objective was to identify structural and managerial factors associated with COVID-19 outbreaks in NHs.
We conducted in July 2020 a retrospective study by questionnaire addressed to NH directors in the Brittany region of France. The questions related to structural characteristics of the establishment, human resources, and crisis management decisions. The primary endpoint was the occurrence of at least one confirmed case of COVID-19 among residents between March 1, 2020 and May 31, 2020. The secondary endpoint was total mortality during this period. We used multivariate regressions to identify factors associated with these outcomes.
Responses were collected from 231 NHs hosting 20,881 residents, representing a participation rate of 47%. In 24 (10%) NHs, at least one resident presented confirmed COVID-19. NHs often implemented stringent protective measures, with 65% of them choosing to confine residents to their rooms. In multivariate analysis, factors associated with a reduced risk of case occurrence were in-room meal service, early ban of family visits, and daily access to an outdoor space. No association was found between mortality and the factors studied. Our results show an early and strict implementation of lockdown measures, with good epidemiological results in a context of shortage of personal protective equipment (PPE) and non-vaccination. Nevertheless, it raises ethical questions concerning respect of residents' wellbeing and rights.
Cessation of communal dining seems to be the main measure likely to be effective in preventive terms. It does not seem that room lockdown and cessation of group activities should be recommended, particularly if mask wearing is possible.