Shortages of PPE fuelled coronavirus spread in Norfolk care homes - UEA study
PUBLISHED: 18:10 02 July 2020 | UPDATED: 18:28 02 July 2020
A lack of personal protective equipment fuelled the spread of coronavirus in Norfolk’s care homes, but maintenance workers, cooks and administrators may have been the reason the virus got into them in the first place - according to researchers.
University of East Anglia researchers studying the speak of COVID-19 in Norfolk found that once the virus was present, its spread was most strongly linked to a lack of PPE, especially facemasks and eye protection.
But their study, which has not yet been peer reviewed by other scientists, found the introduction of the virus into the homes was not dependent on PPE, but on the total numbers of non-care staff working there.
They found COVID-19 was more likely to get into residential care homes when there were more non-care staff such as maintenance people, cooks and those in administrative roles.
The research team looked at staffing levels and PPE availability in 248 care homes across Norfolk in April and early May, where 25 had definite or suspected cases of COVID-19 – about 10 per cent.
Using data in the care home Capacity Tracker database, set up to help care homes flag PPE needs and shortages, they compared the virus’s prevalence with the availability of aprons, eye protection, gloves, masks and hand sanitiser, but also the number and types of staff working in the homes.
They found the risk of COVID-19 entering a care home was just over six times higher in care homes which employed between 11 and 20 non-care workers, nearly 10 times higher in homes employing 21 to 30 non care workers, and almost 19 times higher in homes employing more than 30 non-care workers.
Lead researcher Dr Julii Brainard, from UEA’s Norwich Medical School, said: “This is really interesting because these are not the people who are directly involved in the care of residents.
“We don’t know exactly why this is the case, but it may have been down to low use of PPE among these employees, which means they were more likely to pass on the infection to other staff or during brief time spent near residents.
“Alternatively, non-care workers may be more likely to work part time and possibly work across several locations.
“Low pay and job insecurity means that many people who work in care homes may need to work across multiple settings to have income security.
“Each setting they work in can mean more chances for exposure to infectious people, and higher chances of infection transfer between settings. This is a problem for infection control across the entire care sector.”
Dr Brainard added: “We also found that once introduced into the home, the subsequent spread of COVID-19 was largely associated with inadequate access to PPE, particularly facemasks and eye protection.
“Supplies of PPE to UK care homes have increased since our study monitoring period and we hope this has changed the balance of future risk factors.
“Although our research clearly indicated the importance of PPE to reduce disease spread, we believe that infection prevention and reduction needs to be more multi-faceted than simply supplying adequate PPE and training to use it.”
A limitation to the study was that the data used for it did not indicate counts of agency workers who were most likely to work in multiple care homes - and so could also potentially have played a part in spreading the virus.
The UEA team hopes the work will help inform strategies to control the spread of COVID-19 and other contagious diseases in care homes.
Infectious diseases expert Prof Paul Hunter, also from UEA’s Norwich Medical School, said: “COVID-19 has disproportionately more severe outcomes among the elderly and it has swept through residential care homes in the UK and abroad, with a high number of deaths.
“About 40 per cent of all COVID-19 deaths in the UK in early May 2020 were among care home residents.
“But preventing and controlling infectious disease outbreaks in care settings has many challenges. The sector is under-funded in many countries and staffed by low-paid workers who may have insufficient training or experience in infection control.
“It’s well known that here in the UK, care home workers were not supplied with sufficient PPE such as masks, gloves and protective gowns early in the COVID-19 outbreak.
“This lack of PPE was widely suspected to have contributed to the spread of the disease and deaths in care homes.
“We wanted to see if lack of PPE could be linked to spread of COVID-19 in a real dataset of Norfolk care homes, and if any other factors seemed to be at play.
“We found that once COVID-19 was in a care home then the outbreak was worse where more care staff were employed, but this was much less important than whether they had shortages in certain types of PPE.”
There have been 133 deaths due to coronavirus in Norfolk’s care homes since the first week of April, according to provisional statistics from the Care Quality Commission.
Since April 8, Norfolk County Council has distributed more than 1.5 million items of PPE to adult social care nursing and residential homes.
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