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Prevention Training and Decolonization Reduced COVID-19 in Nursing Homes

Orange County, CA nursing homes that partook in either universal decolonization or prevention training had significantly fewer staff and resident COVID-19 cases than nursing homes that did not.

Like much of the US, Orange County, CA., experienced a surge in COVID-19 cases during winter 2020-2021. Nursing homes (NH) were hit especially hard, and to combat the surge, 24 NHs adopted universal decolonization (chlorhexidine for routine bathing, and twice daily nasal iodophor Monday-Friday every other week). And 12 NHs participated in a COVID-19 preventative training program.

A study presented during IDWeek evaluated the impact of these initiatives on NH staff and resident COVID-19 cases during the surge. The investigators conducted a quasi-experimental study that calculated staff COVID-19 cases, resident cases, and resident deaths, adjusting for average daily NH census.

The decolonization NHs received weekly visits to encourage following protocol, and the training program NHs received three in-person training sessions for all work shifts, in addition to weekly feedback assessing adherence to masking, hand hygiene, and breakroom safety. Investigators evaluated the efficacy of these initiatives using linear mixed effects models to test for correlation between training participation and calendar date when clustering by NH.

Of the 63 OC NHs with available data, 24 adopted universal decolonization, 12 received preventative training (11 of which also adopted decolonization), and 38 did neither. The combined 63 NHs experienced 1867 staff COVID-19 cases, 2186 resident cases, and 251 resident deaths; the investigators divided these into a corresponding 29.6, 34.7, and 4.0 events per each NH.

NHs that participated in either the decolonization or training initiative saw COVID-19 staff cases reduced by 31%, resident cases reduced by 43%, and resident deaths reduced by 26% (nonsignificant).

These results showed that the universal decolonization and preventative training initiatives did reduce COVID-19 cases among staff and residents in participating NHs during the winter 2020-2021 surge.