Session : Late Breaking COVID-19 Abstracts

LB-19 - Association between contract staffing and reported outbreaks of SARS-CoV-2 in a cluster-randomized trial of 965 U.S. nursing homes.

Saturday, October 24, 2020

2:55pm – 3:05pm EDT

Background: Nursing home residents account for 45% SARS-CoV-2 related deaths in the U.S. but only 0.6% of the population. Our research group conducted a large pragmatic cluster randomized influenza vaccine trial in 965 nursing homes (NCT03965195). Due to the pandemic and its impact after the influenza season, we prospectively collected reports of SARS-CoV-2 outbreaks and performed a prospective study on the association between contract staffing and reported outbreaks of SARS-CoV-2. We hypothesized those using more contract nursing care would have higher risk of an outbreak.

Methods: From February through April, we collected monthly facility-level, self-reported data on SARS-CoV-2 outbreaks. Facility characteristics were taken from public data from Centers for Medicaid and Medicare services. Predictors of SARS-CoV-2 outbreaks were identified using a LASSO variable selection procedure, with a generalized linear, Poisson family model. Facility characteristics evaluated include demographics (e.g. number of residents), influenza vaccination rates, quality measures (e.g. % with UTI), and functional status (e.g. % with tube feedings). Facilities with contract staffing hours in the upper 25% quantile of direct care (RN, LPN, CNA) were considered ‘heavy use’.

Results: Of 965 randomized NHs, 663/965 (69%) reported data on SARS-CoV-2 outbreaks. On average, 13% of facilities had at least one outbreak, with 5/842 (0.5%) outbreaks in February, 91/835 (10.8%) in March and 217/686 (30%) in April. SARS-CoV-2 (+) facilities were larger (average total beds, 151 vs. 117), but were mostly similar by functional and cognitive status. Occupancy rate, total residents, Influenza vaccination rate, % with UTI, receiving respiratory treatments, tube feedings, and Medicaid payers were adjusted for in the analysis. The ‘heavy use’ of contract staffing included those with >223 hours per quarter. A multivariable regression found the relative risk SARS-CoV-2 outbreak was 1.56 (95% Confidence Interval: 1.22, 1.99) with heavy use of contract staffing.

Conclusion: The participating nursing homes in our vaccine trial with SARS-CoV-2 outbreaks were larger. Our study highlights that heavy use of contract staffing was associated with 56% increased risk of an outbreak.

Presenter and Author(s)

Stefan Gravenstein, MD MPH

Investigator
Brown University, Alpert Medical School and School of Public Health
Providence, RI

Disclosure: Merck (Advisor or Review Panel member)Pfizer (Consultant, Grant/Research Support, Advisor or Review Panel member)Sanofi (Consultant, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau)Seqirus (Grant/Research Support)

Slides
Stefan Gravenstein, MD MPH

Investigator
Brown University, Alpert Medical School and School of Public Health
Providence, RI

Disclosure: Merck (Advisor or Review Panel member)Pfizer (Consultant, Grant/Research Support, Advisor or Review Panel member)Sanofi (Consultant, Advisor or Review Panel member, Research Grant or Support, Speaker's Bureau)Seqirus (Grant/Research Support)

Slides

Co-Author(s)

KM

Kevin McConeghy, Pharm.D.

Clinical Pharmacy Specialist
COIN-LTSS, Providence Veterans Affairs Medical Center
Providence, Rhode Island

Disclosure: Pfizer (Grant/Research Support)Sanofi-Pasteur (Grant/Research Support)Seqirus Pharmaceuticals (Grant/Research Support)
HD

H. Edward Davidson, PharmD, MPH

Partner
Insight Therapeutics, LLC
Norfolk, Virginia

Disclosure: Sanofi pasteur (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Seqirus (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)
LH

Lisa Han, MPH

Partner
Insight Therapeutics, LLC
Norfolk, Virginia

Disclosure: Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)
ES

Elie Saade, MD, MPH

Assistant Professor
University Hospitals of Cleveland
Cleveland, Ohio

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DC

David Canaday, M.D.

Associate Professor
University Hospitals of Cleveland
Cleveland, Ohio

Disclosure: Pfizer (Research Grant or Support)Sanofi Pasteur (Research Grant or Support)Seqirus (Advisor or Review Panel member, Research Grant or Support)
VM

Vincent Mor, Ph.D.

Professor
Brown University, School of Public Health
Providence, Rhode Island

Disclosure: naviHealth (Consultant)