Best practices in LTC: the role of COVID surface testing

nurses and doctors group


1. Long-term care communities are disproportionately affected by COVID-19

Nursing home residents were among the first known cases of COVID-19 in the US and residents of nursing homes and long-term care facilities have accounted for a staggering proportion of COVID-19 deaths in the US. Since the coronavirus outbreak began in the US in a nursing home in Kirkland, Washington, more than 230,000 residents and employees of 9192 nursing homes have contracted COVID-19, accounting for 45% of the country’s COVID-19-related deaths (8). The major characteristic of COVID-19 compared to other known respiratory diseases is that it is very highly contagious, allowing it to spread extremely quickly. In the Kirkland facility, less than a month after the first case was confirmed, a total of 167 cases of COVID-19 were confirmed, affecting 101 residents and 50 health care personnel. Those statistics appear to tell the national story. According to the CDC, over 95% of the staff members, visitors and residents who got sick and died in Kirkland were older residents. In Rhode Island and Minnesota, deaths in nursing home residents account for 81% and 78% of total state deaths respectively (8).


2. Insufficient guidelines leave the LTC community feeling of helplessness

The vulnerable nature of the nursing home population combined with the inherent risks of congregate living in a healthcare setting, requires aggressive efforts to
limit COVID-19 exposure and to prevent the spread of the disease within long-term care facilities and nursing homes. A strong infection prevention and control (IPC) program is critical to protect both residents and healthcare personnel (HCP). As of today, most US long-term care facilities are in a posture that can be described as their highest level of vigilance. Yet, the number of COVID-19 cases and death remains alarmingly high (8), leaving facility managers feeling like they are playing catch-up and putting out fires — “It’s a very helpless feeling.” (9). Part of the issue is that current protocols focus on infection prevention and testing of symptomatic people. That is because due to limited testing capacity, most state nursing homes and long-term care facilities are still only able to test residents with symptoms, even though the disease is known to spread via non-symptomatic people. “What I would like to see is the ability to test the entire nursing homes,” says Dr. Sunil Parikh, infectious disease specialist at Yale School of Public Health in Connecticut. “This symptomatic approach is just not cutting it.” (7). The issue with this approach is that non-symptomatic (asymptomatic and pre-symptomatic) COVID-19 infected individuals, despite being contagious do not get detected early and infected staff members continue to work, sometimes in roles that require close proximity with at-risk patients and residents.


"Facility managers feel like they are playing catch-up and putting out fires. Families feel helpless."


3. Stringent CMS requirements for LTCs to remain open will be hard to maintain

The 3-phase approach to “Reopening nursing homes and Opening Up America Again” (2) calls for very stringent requirements that will be hard to fulfill with the current conventional approach. In particular, the CMS guidelines call for no rebound in cases after 14 days, no new COVID cases in the nursing home for 14 days and no staff shortages (2). “If a facility identifies a new, nursing home onset COVID-19 case in the facility while in any phase, that facility goes back to the highest level of mitigation and starts over even if the community is in phase 3” (2). In addition, “states may choose to have a longer waiting period (e.g., 28 days) before relaxing restrictions for facilities that have had a significant outbreak of COVID-19 cases.” In order to remain open and operational, retaining the trust of residents and their families and ultimately remain financially viable, long-term care facilities must adapt and harness the power of environmental testing.


4. Encouraging results for COVID-19 surface testing to regain control in LTCs

A study performed in over 50 long-term care facilities within the last 2 months has demonstrated that incorporating routine testing of high-traffic surfaces to detect SARS-CoV-2 allows facilities to know whether and when the virus was introduced in the facility, independently of the onset of symptoms in staff or residents. Nursing home residents are at high risk for infection, serious illness, and death from COVID-19 and COVID-19 enters LTC facilities through the people who work there. Many nursing home residents have become very sick and some have died after Staff in their building worked while they were sick (4). Surface testing allows multiple participating facilities to take a data-driven and proactive approach and take early measures to protect their residents from a potentially devastating outbreak. Once viral particles were detected on the surfaces tested, such as clocking devices or elevator buttons, it was clear that a member of the community was infected and shedding the virus. With this knowledge, those facilities immediately performed tests on every individual and quickly identified and isolated infected staff members. COVID-19 surface tests were also used during this study as a way to validate the efficacy of cleaning protocols, with some facilities implementing drastic changes to their cleaning methods when viral particles were still detected after cleaning.

"Once viral particles were detected on [...]  clocking devices or elevator buttons, it was clear that a member of the community was infected."


Watch the recording:

We share the result of a nationwide study showing that long-term care communities use of COVID-19 surface testing helped them regain control over the pandemic, protect seniors, retain their families’ trust and safeguard financial viability.


5. Conclusions

Viral testing in nursing homes and long-term care communities, both from surfaces and individuals, with nucleic acid or antigen detection assays, is an important addition to other infection prevention and control (IPC) recommendations aimed at preventing SARS-CoV-2 from entering nursing homes, detecting cases quickly, and stopping transmission. Surface testing should be implemented in long-term care facilities and nursing homes in addition to recommended IPC measures. Enviral Tech’s Surface testing has a rapid turnaround time (less than 24 hours), which facilitates effective interventions and empowers long-term care communities to truly take control over outbreak and keep their residents safe.


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  1. CDC- Preparing for COVID-19 in Nursing Homes
  2. The Centers for Medicare and Medicaid Services (CMS) - Nursing Home Reopening Guidance for State and Local Officials
  3. CDC- Testing guidelines for nursing homes
  4. CDC-COVID-19 Prevention Messages for Front Line Long-Term Care Staff (video)
  5. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington N Engl J Med 2020
  6. Track COVID-19 Nursing Home Cases, Deaths in Your State
  7. Covid-19: nursing homes account for 'staggering' share of US deaths, data show
  8. Kaiser Family Foundation Coronavirus statistics
  9. Relatives watch as covid-19 tears through Seattle-area senior homes. ‘It’s a very helpless feeling.’


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