Coaching, Collaboration, Cleaning, & Communication: 4C Intervention to Reduce SARS-CoV-2 Transmission
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ABSTRACT COVID-19 has spread rapidly across the globe in the six months since the novel coronavirus SARS-CoV-2 was first detected in a cluster of patients with community-acquired pneumonia in Wuhan, China. As of June 10, 2020, the Centers for Disease Control and Prevention (CDC) reports over 1.9 million COVID-19 cases and 112,133 deaths in the US; the World Health Organization (WHO) reports over 7.1 million cases and 408,025 deaths worldwide (in 216 countries). Advanced age and underlying conditions are risk factors for ICU admission with COVID-19 infection, meaning nursing home (NH) residents are at greater risk for severe illness. At the same time, NHs have long faced special challenges in implementing effective infection prevention programs, including limited resources and diagnostic challenges in a frail functionally disabled long-stay population. To date, approximately one in three deaths from the virus in the US have been linked to NHs or other long-term care facilities. Anticipating that the virus will return in the fall of 2020, advancing our understanding of the transmission of SARS-CoV-2 within these facilities for vulnerable populations deserves urgent and further investigation. Environmental contamination with SARS-CoV-2 that is reported in limited studies highlights the potential importance of transmission between patients, their environment, and healthcare providers via direct and indirect contact. With this proposal, we plan to characterize the epidemiology of SARS- CoV-2 in the NH patient room environment over time and the risk of transmission to near and far environments, with the explicit intent of developing integrated, simple COVID-19 infection prevention strategies. We will achieve these goals through the following aims. Specific Aim 1: Characterize transmission of the SARS-CoV- 2 virus within post-acute care settings including patient rooms and common use areas such as nurses' stations, dining areas and recreation areas. We will conduct a prospective longitudinal study of older adults with active COVID-19 infection at 4 NHs with designated COVID-19 units to describe risk factors for virus transmission. We hypothesize that risk factors including functional disability, comorbidities, and COVID-19 symptom severity will be associated with increased odds of SARS-CoV-2 transmission to the environment among residents with active COVID-19 infections. Specific Aim 2: Using a cluster-randomized study design, we will test a multimodal aging-friendly intervention including four components (4Cs): 1) Coaching: infection prevention coaching to observe, teach, and audit evidence-based infection prevention practices by all frontline clinicians; 2) Cleaning: standardized recommended environmental cleaning protocols with feedback on environmental contamination; 3) Communication: patient and family communication strategy and implementation of patient hand hygiene and recommended PPE use; and 4) Collaboration: rapid testing, re- testing and contact tracing, in collaboration with referral hospitals. We hypothesize that the implementation of this intervention will be associated with lower odds of SARS-CoV-2 transmission to the environment.
