Built Environment and SARS-CoV-2 Transmission in Long-Term Care Facilities: Cross-Sectional Survey and Data Linkage.
Maria Krutikov, Oliver Stirrup, Chris Fuller and 8 others
PMID 38065220WHAT IT FOUND
Community SARS-CoV-2 incidence, not building features, tracked outbreak introduction in care homes.
Resident infection rates were linked to more bedrooms and purpose-built design, but this observational study cannot prove cause.
Key findings
01Outbreak introduction was associated only with local community SARS-CoV-2 incidence: comparing high versus low community incidence gave an adjusted rate ratio of 2.84, and building factors showed no associations.
02In overall models, each extra storey was associated with a 36% lower resident infection rate (adjusted rate ratio 0.64 per storey), while purpose-built versus converted buildings had a 1.99 times higher rate and each extra bedroom a 1.04 times higher rate.
03Secondary outbreak outcomes were linked to subjective or time-varying factors: outbreaks had 46% more cases when common-room air was perceived dry, and each 1°C higher bedroom temperature prolonged outbreaks by 15%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The built environment was measured once by staff or managers, so facilities may have changed cleaning, ventilation or isolation after outbreaks, and reverse causality cannot be ruled out. Many survey answers were subjective or incomplete, with completeness ranging from 6% to 97%, and temperatures above 30°C were treated as missing. The study tested many building factors, so some associations may have occurred by chance. The sample was convenience-based and included more for-profit and larger facilities than the national average. Routine test data could miss infections, and changing testing and prevention policies over the study period were difficult to account for fully. The analysis did not measure actual airflow, filters or room-level ventilation performance, so ventilation associations are indirect.
The easy way to misread this
Do not conclude that changing storeys, bedrooms, ventilation, cleaning or air quality will reduce SARS-CoV-2 transmission. The building survey was cross-sectional, many answers were subjective or incomplete, and facilities may have changed cleaning or isolation after outbreaks occurred, so the associations are not proof of cause.