Impact of long-term care facility size on preparedness and adherence to infection prevention and control guidance for the mitigation of COVID-19

Aim To evaluate the preparedness and adherence of Brazilian long-term care facilities (LTCFs) to the World Health Organization (WHO) infection prevention and control (IPC) guidance and examine the association of LTCF size with adherence to recommendations. Methods We conducted a cross-sectional study of LTCF managers for 12 consecutive weeks from May 5, 2020. We developed and pre-tested a 46-item questionnaire based on WHO IPC guidance that included multiple-choice and dichotomous questions as well as an open-ended question on the main difficulties encountered by the facility in tackling the pandemic. Using a global adherence score based on the adoption of 20 recommendations, we classified preparedness as (1) excellent for LTCFs following ≥14 recommendations, (2) good for those following 10-13 recommendations, and (3) poor for those following <10 recommendations. LTCF size was established as small, medium, and large according to a 2-step cluster analysis of the number of residents as a continuous variable. We used descriptive statistics and chi-square tests at a 5% significance level. Results Of 362 facilities included in the study, 308 (85.1%) adhered to 14 or more recommendations; 3 were classified as poorly adherent. Regarding LTCF size, we found a lower adherence to screening visitors for COVID-19 signs and symptoms (p=0.037) and to isolating patients until they have 2 negative laboratory tests (p=0.032) in larger facilities than in medium and small facilities. Conclusions Preparedness for mitigating COVID-19 in Brazilian LTCFs was considered excellent for most of the proposed recommendations, regardless of LTCF size. Difficulties and problems with infrastructure and/or resident care were much less commonly reported than those related to maintenance of a sufficient stock of materials, workforce management, and financial distress.