Have infection control and prevention measures resulted in any adverse outcomes for care home and domiciliary care residents and staff?

  1. Review Team
  2. Llinos Haf Spencer
  3. Ned Hartfiel
  4. Annie Hendry
  5. Bethany Anthony
  6. Abraham Makanjuola
  7. Report Team
  8. Nathan Bray
  9. Dyfrig Hughes
  10. Clare Wilkinson
  11. Deb Fitzsimmons
  12. Rhiannon Tudor Edwards
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Abstract

What is a Rapid Review?

Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/question(s), the extent of the evidence base and type of analysis required for synthesis.

Background / Aim of Rapid Review

Care for older and vulnerable people must sustain core infection prevention and control (IPC) practices and remain vigilant for COVID-19 transmission to prevent virus spread and protect residents and healthcare professionals from severe infections, hospitalisations and death.

However, these measures could potentially lead to adverse outcomes such as decreased mental wellbeing in patients and staff. A recent publication by Public Health England examines the effectiveness of IPC practices for reducing COVID-19 transmission in care homes (Duval et al., 2021). We explore evidence relating to adverse outcomes from IPC practices to help inform policy recommendations and identify gaps within the literature where further research can be prioritised.

Key Findings

Extent of the evidence base

  • 15 studies were identified: 14 primary studies and one rapid review

Recency of the evidence base

  • Of the primary studies, six were published in 2020 and eight were published in 2021

  • The rapid review was published in 2021.

Summary of findings

This rapid review focuses on adverse outcomes resulting from increased IPC measures put in place during the COVID-19 pandemic. Whilst there is some evidence to show that there may be a link between IPC measures and adverse outcomes, causation cannot be assumed.

  • During the COVID-19 restrictions, the cognition, mental wellbeing and behaviour of residents in care homes were negatively affected

  • Increased IPC procedures during the COVID-19 pandemic increased stress and burden among care staff because of increased workload and dilemmas between adhering well to IPC procedures and providing the best care for the care recipients

  • COVID-19 IPC procedures were not well developed at the beginning of the COVID-19 pandemic, but evidence from 2021 suggests that good adherence to IPC measures can enable visitations by family members and medical professionals into care homes

  • Only one study investigating domiciliary care was found. Therefore, it is difficult to make conclusions related specifically to this care setting

  • No published studies have reported on the costs or cost-effectiveness of IPC measures or have explored the cost implications of adverse outcomes associated with IPC measures

Best quality evidence

Only one study was deemed as high quality based on the quality appraisal checklist ranking. This was a mixed methods study design (Tulloch et al., 2021).

Policy Implications

Since March 2020, there have been many changes to government guidelines relating to procedures to keep the population safe from COVID-19 harm. Policies vary according to country, even within the UK. Important issues such as care home visitation policies have changed in such a way that care home staff have felt it difficult to keep up with the changes, which in itself increased the burden on those staff. The following implications were identified from this work:

  • IPC policies should be clear, concise and tailored to care homes and domiciliary care settings

  • Increased attention to workforce planning is needed to ensure adequate staffing and to reduce individual burden

  • Restrictions (e.g. visitation) for care home residents needs to be balanced by additional psychological support

  • Further research with robust methods in this area is urgently needed especially in the domiciliary care setting

Strength of Evidence

One limitation is the lack of high-quality evidence from the included studies. Confidence in the strength of evidence about adverse outcomes of COVID-19 IPC procedures was rated as ‘low’ overall. Whilst the majority of studies achieved a ‘moderate’ score based on the quality appraisal tools used, due to the nature of the methods used, the overall quality of evidence is low.

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