Newly Developed COVID-19 Bundle Greatly Reduces the Infection Fatality Rate for a Highly Vulnerable Nursing Home Population.

Finger, Howard J; Rao, Rani N; Sansone, Giorgio R; Hazel, Edouard J; Silvestri-Tan, Carmentina T

This performance improvement initiative used a bundle designed to reduce the COVID-19 infection fatality rate (IFR) by ≥33% and the new infection rate (IR) to <1% among nursing home (NH) residents over a 3-month period at a large public NH in New York City. Participants were all NH residents, newly testing COVID-19 PCR positive between March 1, 2020 and June 30, 2020. Key bundle components involved close observation of all residents with vital signs taken once/shift, including O2 saturation, frequent clinical team follow-up visits for those symptomatic, and ramped-up COVID-19 PCR testing. From April to June, average IFR was 12.3%, a 49.6% reduction from the March baseline (P < 0.05), and average new IR was 5.4%, a 29.9% reduction from baseline (P < 0.05). In the 2 follow-up months, no deaths occurred with a new IR < 1%, indicating sustained improvement. Because of its simplicity, this bundle or components of it could be readily applied elsewhere after appropriate assessment.