Comparing multiple infection control measures in a nursing home setting: a simulation study

Haomin Li; Daniel K Sewell; Ted Herman; Sriram V Pemmeraju; Alberto M Segre; Aaron C Miller; Philip M Polgreen; CDC MInD-Healthcare Group

doi:10.1017/ice.2024.43

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Comparing multiple infection control measures in a nursing home setting: a simulation study

Journal article

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Comparing multiple infection control measures in a nursing home setting: a simulation study

Haomin Li, Daniel K Sewell, Ted Herman, Sriram V Pemmeraju, Alberto M Segre, Aaron C Miller, Philip M Polgreen and CDC MInD-Healthcare Group

Infection control and hospital epidemiology, Vol.45(7), pp.872-879

07/2024

DOI: 10.1017/ice.2024.43

PMCID: PMC11439596

PMID: 38487822

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Abstract

Objective: Compare the effectiveness of multiple mitigation measures designed to protect nursing home residents from infectious disease outbreaks. Design: Agent-based simulation study. Setting: Simulation environment of a small nursing home. Methods: We collected temporally detailed and spatially fine-grained location information from nursing home healthcare workers (HCWs) using sensor motes. We used these data to power an agent-based simulation of a COVID-19 outbreak using realistic time-varying estimates of infectivity and diagnostic sensitivity. Under varying community prevalence and transmissibility, we compared the mitigating effects of (i) regular screening and isolation, (ii) inter-resident contact restrictions, (iii) reduced HCW presenteeism, and (iv) modified HCW scheduling. Results: Across all configurations tested, screening every other day and isolating positive cases decreased the attack rate by an average of 27% to 0.501 on average, while contact restrictions decreased the attack rate by an average of 35%, resulting in an attack rate of only 0.240, approximately half that of screening/isolation. Combining both interventions impressively produced an attack rate of only 0.029. Halving the observed presenteeism rate led to an 18% decrease in the attack rate, but if combined with screening every 6 days, the effect of reducing presenteeism was negligible. Altering work schedules had negligible effects on the attack rate. Conclusions: Universal contact restrictions are highly effective for protecting vulnerable nursing home residents, yet adversely affect physical and mental health. In high transmission and/or high community prevalence situations, restricting inter-resident contact to groups of 4 was effective and made highly effective when paired with weekly testing.

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Details

Title: Subtitle: Comparing multiple infection control measures in a nursing home setting: a simulation study
Creators: Haomin Li - Department of Biostatistics, University of Iowa, Iowa City, IA, USA
Daniel K Sewell - University of Iowa
Ted Herman - University of Iowa
Sriram V Pemmeraju - Department of Computer Science, University of Iowa, Iowa City, IA, USA
Alberto M Segre - University of Iowa
Aaron C Miller - University of Iowa
Philip M Polgreen - University of Iowa
CDC MInD-Healthcare Group
Resource Type: Journal article
Publication Details: Infection control and hospital epidemiology, Vol.45(7), pp.872-879
DOI: 10.1017/ice.2024.43
PMID: 38487822
PMCID: PMC11439596
NLM abbreviation: Infect Control Hosp Epidemiol
eISSN: 1559-6834
Publisher: Cambridge University Press
Language: English
Electronic publication date: 03/15/2024
Date published: 07/2024
Academic Unit: Infectious Diseases; Epidemiology; Biostatistics; Nursing; Fraternal Order of Eagles Diabetes Research Center; Injury Prevention Research Center; Computer Science; Public Policy Center (Archive); Internal Medicine
Record Identifier: 9984572458202771

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