Journal Article

A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control

Lee, Min Hye, Lee, Seong Hyeon, Park, Yeon-Hwan, Lee, Gyeoung Ah

2020

Overview

The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively. The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs. Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies. A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks. This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Bias / Communicable diseases / Cross Infection - epidemiology / Cross Infection - prevention & control / Decontamination / Disease Outbreaks - prevention & control / Disease transmission / Diseases / Epidemics / Hand Hygiene - organization & administration / Hand Hygiene - standards / Hand Hygiene - statistics & numerical data / Health aspects / Hepacivirus - isolation & purification / Hepatitis / Hepatitis B / Hepatitis B - epidemiology / Hepatitis B - prevention & control / Hepatitis B - transmission / Hepatitis B - virology / Hepatitis B virus - isolation & purification / Hepatitis C - epidemiology / Hepatitis C - prevention & control / Hepatitis C - transmission / Hepatitis C - virology / Humans / Hygiene / Hygiene - standards / Identification methods / Infection control / Infection Control - organization & administration / Infection Control - standards / Infection Control - statistics & numerical data / Infections / Infectious diseases / Influenza / Influenza viruses / Influenza, Human - epidemiology / Influenza, Human - prevention & control / Influenza, Human - transmission / Influenza, Human - virology / Living conditions / Long term care / Long term care facilities / Long term health care / Long-Term Care - organization & administration / Long-Term Care - standards / Long-Term Care - statistics & numerical data / Medicine and Health Sciences / Nursing / Orthomyxoviridae - isolation & purification / Orthomyxoviridae - pathogenicity / Outbreaks / Pathogenic microorganisms / Pathogens / Personal hygiene / Pharmaceuticals / Prejudice / Prevention / Quality / Residential Facilities - organization & administration / Residential Facilities - standards / Residential Facilities - statistics & numerical data / Severe acute respiratory syndrome / Streptococcal Infections - epidemiology / Streptococcal Infections - microbiology / Streptococcal Infections - prevention & control / Streptococcal Infections - transmission / Streptococcus infections / Streptococcus pyogenes - isolation & purification / Studies / Surveillance / Systematic review / Viruses