Contract staffing in nursing homes linked to SARS-CoV-2 outbreaks

Heavy use of contract staffing was associated with an increased risk for a COVID-19 outbreak in nursing homes, according to research presented at this year’s virtual IDWeek.

“Nursing home residents account for just over 40% of SARS-CoV-2-related deaths in the U.S., and staff are a known vector of transmission,” Stefan Gravenstein, MD, MPH, a professor at Brown University’s Alpert Medical School and School of Public Health, said during the presentation. “Nursing homes, which utilize more contract nursing, may have more transmission of contagious infections, and contract nursing may also be a proxy for nursing home quality.”

Gravenstein and colleagues conducted a large, pragmatic cluster randomized influenza vaccine trial in 965 nursing homes across the United States. During the trial, they also prospectively collected data on SARS-CoV-2 outbreaks from February through April to evaluate the association between contract staffing and reported outbreaks.

Among the nursing homes, 69% reported information on SARS-CoV-2 outbreaks, and 13% of facilities had at least one reported outbreak, the researchers found. Of the reported outbreaks, 0.5% occurred in February, 10.8% occurred in March and 30% occurred in April.

Gravenstein and colleagues determined that facilities with SARS-CoV-2 outbreaks were larger — with an average of 151 beds in facilities with outbreaks and 117 beds in those without — but were otherwise similar in functional and cognitive status.

They also found that facilities that had heavy use of contract staffing — more than 223 hours per quarter — had a relative risk for SARS-CoV-2 outbreaks of 1.56 (95% CI , 1.22-1.99).

“We conclude that we observed facilities with heavy use of contacted staffing also had a higher risk of SARS-CoV-2 [in the] early period of the pandemic,” Gravenstein said during the presentation.