PDF(Pubmed)
Abstract：
BACKGROUND: The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear.
METHODS: We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE.
RESULTS: We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems.
CONCLUSIONS: Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics.
BACKGROUND: CRD42022344149.
METHODS: We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE.
RESULTS: We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems.
CONCLUSIONS: Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics.
BACKGROUND: CRD42022344149.
摘要：
背景：SARS-CoV-2大流行强调了大流行准备的必要性，与呼吸道传播的病毒被认为是一个重大的风险。在大流行中，长期护理设施(LTCF)是一个高风险环境,具有严重的暴发和疾病负担.当药物干预不可用时,非药物干预(NPI)构成主要防御机制。然而,关于LTCF中实施NPI有效性的证据仍不清楚.
方法：我们进行了一项系统评价，评估了在LTCF中实施NPI的有效性，以保护居民和工作人员免受具有大流行潜力的病毒性呼吸道病原体的影响。我们搜查了Medline,Embase,CINAHL,和2022年9月2日的两个COVID-19登记册。筛选和数据提取由两名经验丰富的研究人员独立进行。我们纳入了随机对照试验和干预效果的非随机观察性研究。使用ROBINS-I和RoB2进行质量评价。主要结果包括爆发次数，感染,住院治疗,和死亡。我们叙述地综合了研究结果，专注于效果的方向。使用等级评估证据确定性（CoE）。
结果：我们分析了13项观察性研究和3项（成组）随机对照试验。所有研究都是在高收入国家进行的，除三个人以外，其他所有人都集中在SARS-CoV-2上，其余的则集中在流感或上呼吸道感染上。证据表明，不同措施和手部卫生干预措施的组合可以有效地保护居民和工作人员免受感染相关结果的影响（中度CoE）。员工与居民的自我约束，LTCF工作人员的分工，以及对LTCF中的居民和/或工作人员的常规测试，其中,可能是有效的(低CoE)。其他措施,比如限制共享空间，在房间里用餐，队列感染和未感染的居民可能是有效的(非常低的CoE)。证据差距图突出了重要干预措施缺乏证据，包括访问限制，进入前测试，和空气过滤系统。
结论：尽管大多数结局的干预措施CoE较低或非常低，在本次审查中确定为潜在有效的NPI的实施通常是唯一可行的选择，特别是在接种疫苗之前。我们的证据差距图强调了进一步研究几种干预措施的必要性。需要解决这些差距，以便为未来的流行病做好准备。
背景：CRD42022344149.
方法：我们进行了一项系统评价，评估了在LTCF中实施NPI的有效性，以保护居民和工作人员免受具有大流行潜力的病毒性呼吸道病原体的影响。我们搜查了Medline,Embase,CINAHL,和2022年9月2日的两个COVID-19登记册。筛选和数据提取由两名经验丰富的研究人员独立进行。我们纳入了随机对照试验和干预效果的非随机观察性研究。使用ROBINS-I和RoB2进行质量评价。主要结果包括爆发次数，感染,住院治疗,和死亡。我们叙述地综合了研究结果，专注于效果的方向。使用等级评估证据确定性（CoE）。
结果：我们分析了13项观察性研究和3项（成组）随机对照试验。所有研究都是在高收入国家进行的，除三个人以外，其他所有人都集中在SARS-CoV-2上，其余的则集中在流感或上呼吸道感染上。证据表明，不同措施和手部卫生干预措施的组合可以有效地保护居民和工作人员免受感染相关结果的影响（中度CoE）。员工与居民的自我约束，LTCF工作人员的分工，以及对LTCF中的居民和/或工作人员的常规测试，其中,可能是有效的(低CoE)。其他措施,比如限制共享空间，在房间里用餐，队列感染和未感染的居民可能是有效的(非常低的CoE)。证据差距图突出了重要干预措施缺乏证据，包括访问限制，进入前测试，和空气过滤系统。
结论：尽管大多数结局的干预措施CoE较低或非常低，在本次审查中确定为潜在有效的NPI的实施通常是唯一可行的选择，特别是在接种疫苗之前。我们的证据差距图强调了进一步研究几种干预措施的必要性。需要解决这些差距，以便为未来的流行病做好准备。
背景：CRD42022344149.
