Previous investigations have identified high rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes reporting an outbreak of coronavirus disease 2019 (COVID-19). We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London.
Between 18 and 27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by reverse transcription polymerase chain reaction and subsequent whole-genome sequencing. Residents and staff in two care homes were re-tested 8 days later.
Four care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3 and 59%. Among residents, positivity ranged between 3 and 76% compared with 3 and 40% in staff. Half of the SARS-CoV-2-positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introduction of the virus into care homes, and distinct clusters within three of the care homes.
We found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. Although routine whole-home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures.

We experienced a case involving a 67-year-old man with Alzheimer\'s disease who exhibited criminal behaviour. Although his behaviour improved after admission to a long-term care facility, he was not able to return to his home because he was suspected of theft. At 62 years of age, he developed slowly progressive memory loss and had difficulty managing money. He was diagnosed with Alzheimer\'s disease and began taking galantamine. He was placed in police custody after he had tried to take another person\'s fuel tank early one morning. However, he was not charged with theft because he did not remember his actions. Because it was difficult for his sister to constantly monitor him, he was admitted to a long-term care facility. He displayed high emotional insecurity and continually asked when he could return home. His physical function was good, enabling him to perform various activities alone, but he experienced the delusion of theft during these activities. He appealed the decision prohibiting him from going home. However, the staff suggested that he would exhibit problematic behaviours at home, and it was decided that he should not live at home. After living at the long-term care facility for 3 years, he died of acute cardiac infarction. When a person goes to jail for committing a crime, that person can return to society after completing a jail term. That was not the case with this man with Alzheimer\'s disease. As such, guidelines and standards to evaluate the criminal responsibility of dementia patients need to be established.

OBJECTIVE: This study aims to understand the factors that contribute to supervisory nurse performance in long-term care facilities.
BACKGROUND: Long-term care facilities have been faced with staffing challenges and increasing resident care needs, resulting in suboptimal quality of care. Nursing leadership has been identified as a key factor in the provision of high-quality care.
METHODS: The comparative case study employed a complexity science framework to compare two facilities. The facilities were chosen based on the level of perceived supervisory support staff received from their supervisors, and 10 participants were recruited from each facility at various levels of management and staff (n = 20). Data were collected in 2015 using semi-structured interviews.
RESULTS: The quality and quantity of supervisory relationships was central to shaping the effectiveness of the supervision. Effective supervisory support was characterized by frequent and high-quality supervisor-staff interactions. Effective nurse supervisors acknowledged self-organisation as beneficial, and worked in environments that encouraged fluidity of roles.
CONCLUSIONS: The findings suggest that effective nurse supervisors and supervisory support fosters improved work environments and the staff\'s ability to respond to residents\' needs in a timely, effective and compassionate manner.
CONCLUSIONS: Nurse managers who provide effective supervisory support can improve the quality of care provided to their residents.

BACKGROUND: Amantadine hydrochloride remains an inexpensive means of influenza A prophylaxis, but it is reported to have a high incidence of adverse drug reactions (ADRs) in residents of long-term care facilities (LTCFs) compared with newer, more expensive drugs.
OBJECTIVE: This study attempted to determine the effects of poor renal function on the rate of ADRs and any other variables on the tolerability of prophylaxis in this population. This would allow a high-risk subset of LTCF residents to be identified before prophylaxis, thus decreasing the risk for ADRs from amantadine.
METHODS: In this retrospective case-control study, a course of standardized low-dose (100-mg/d tablets) amantadine prophylaxis was ordered for all 242 residents of Ten Broeck Commons LTCF in Lake Katrine, New York, without influenza A for 14 days. Chart data of residents who developed ADRs (ADR group) were compared with those of a selected group who did not (control group). Residents\' age, sex, renal function (blood urea nitrogen, serum creatinine, and creatinine clearance), dementia diagnosis, and number and classes of medications were compared.
RESULTS: The ADR group comprised 25 residents (21 women, 4 men; mean [SD] age, 84.8 [8.4] years); the control group, 29 residents (23 women, 6 men; mean [SD] age, 85.7 [7.5] years). The development of ADRs was not associated with differences in age, sex, renal function, or any medical condition, including measured, preexisting mental status changes between the groups. The overall risk for ADRs in the 242 residents was highest between days 8 and 14 of prophylaxis (17 residents [7.0%]) compared with the first 7 days (8 residents [3.3%]). Acute confusion was the most common ADR. All ADRs resolved on cessation of treatment.
CONCLUSIONS: No preexisting medical condition was statistically associated with an increased risk for ADRs, but an association with the number of days of prophylaxis was observed. By shortening prophylaxis to 7 days, the ADR risk may be lowered to be commensurate with more expensive medications.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established risk factor for subsequent infection and a key event in interindividual transmission. Some studies have showed an association between fluoroquinolones and MRSA colonization or infection. The present study was performed to identify specific risk factors for MRSA acquisition in long-term care facilities (LTCFs).
METHODS: A prospective cohort of patients naive for S. aureus colonization was established and followed (January 2008 through October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factors were assessed weekly for 13 weeks after inclusion. Variables associated with S. aureus acquisition were identified in a nested-matched case-case-control study using conditional logistic regression models. Cases were patients who acquired MRSA (or methicillin-sensitive S. aureus [MSSA]). Patients whose nasal swab samples were always negative served as controls. Matching criteria were center, date of first nasal swab sample, and exposure time.
RESULTS: Among 451 included patients, 76 MRSA cases were matched to 207 controls and 112 MSSA cases to 208 controls. Multivariable analysis retained fluoroquinolones (odds ratio, 2.17; 95% confidence interval, 1.01-4.67), male sex (2.09; 1.10-3.98), and more intensive care at admission (3.24; 1.74-6.04) as significantly associated with MRSA acquisition, and body-washing assistance (2.85; 1.27-6.42) and use of a urination device (1.79; 1.01-3.18) as significantly associated with MSSA acquisition.
CONCLUSIONS: Our results suggest that fluoroquinolones are a risk factor for MRSA acquisition. Control measures to limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.