Risk factors associated with SARS-CoV-2 infection and outbreaks in Long Term Care Facilities in England: a national survey

Shallcross, L.; Burke, D.; Abbott, O.; Donaldson, A.; Hallatt, G.; Hayward, A.; Hopkins, S.; Krutikov, M.; Sharp, K.; Wardman, L.; Thorne, S.

Background: Outbreaks of SARS-CoV-2 have occurred worldwide in Long Term Care Facilities (LTCFs), but the reasons why some facilities are particularly vulnerable to infection are poorly understood. We aimed to identify risk factors for SARS-CoV-2 infection and outbreaks in LTCFs. Methods: Cross-sectional survey of all LTCFs providing dementia care or care to adults >65 years in England with linkage to SARS-CoV-2 test results. Exposures included: LTCF characteristics, staffing factors, and use of disease control measures. Main outcomes included risk factors for infection and outbreaks, estimated using multivariable logistic regression, and survey and test-based weighted estimates of SARS-CoV-2 prevalence. Findings: 5126/9081 (56%) LTCFs participated in the survey, with 160,033 residents and 248,594 staff. The weighted period prevalence of infection in residents and staff respectively was 10.5% (95% CI: 9.9-11.1%) and 3.8% (95%: 3.4-4.2%) and 2724 LTCFs (53.1%) had at least one case of infection. Odds of infection and/or outbreaks were reduced in LTCFs that paid sickness pay, cohorted staff, did not employ agency staff and had higher staff to resident ratios. Higher odds of infection and outbreaks were identified in facilities with more admissions, lower cleaning frequency, poor compliance with isolation and for profit status. Interpretation: Half of LTCFs had no cases suggesting they remain vulnerable to outbreaks. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with isolation. Funding: UK Government Department of Health & Social Care