SARS–CoV-2 Clusters in Long Term Care Facilities Post Remote Infection Control Assessment and Response

BACKGROUND: During the COVID-19 pandemic, the state health department (SHD) has deployed a team of Infection Preventionists (IPs) to perform Infection Control Assessment and Response (ICAR) visits to bolster a Long-Term Care Facility's (LTCF) infection prevention and control practices. In addition to the standard practice of on-site ICARS, the SHD implemented remote, technologically assisted, ICARS due to the pandemic conditions. METHODS: From March 2020 through October 2021, each ICAR performed, and COVID-19 cluster in a LTCF were tracked using REDCap. A cluster event post-ICAR was defined as one or more new COVID-19 case occurring between 10 to 90 days after an ICAR. Analysis was performed using SAS 9.4 to determine if remote versus on-site ICAR visits had an impact on cluster events post-ICAR and if LTCF type was a confounder. RESULTS: A total of 436 clusters at facilities had a corresponding ICAR from March 2020-October 2021. Of those clusters, 62 (14.22%) occurred in the timeframe of interest and 374 (85.78%) occurred outside the timeframe of interest. Of the clusters that occurred post-ICAR, 40 (64.52%) occurred following an on-site ICAR visit and 22 (35.48%) occurred following a remote visit. Remote ICARs had 1.045 times the odds of a cluster occurring post-ICAR as compared to on-site ICARs, but it was not significant (95% CI: 0.60 – 1.83). After adjusting for confounding, remote ICARs had 1.090 the odds of a cluster occurring following an ICAR, but it was not significant (95% CI: 0.62 – 1.93). CONCLUSIONS: The COVID-19 pandemic presented unique challenges that required adaptations, such as conducting remote ICAR consultations. The analysis demonstrates that remote ICARS do not have a significant impact on a COVID-19 cluster event occurring in a LTCF. Given the flexibility remote ICARs have granted both SHDs and LTCFs, remote ICARs are a tool that should continue to be utilized into the future.