Three-Tiered COVID-19 Cohorting Strategy and Implications for Memory-Care.
Maggie Collison, Kimberly J Beiting, Jacob Walker and 7 others
PMID 33138937WHAT IT FOUND
Cohorting residents into red, yellow, and green groups based on testing and exposure risk contained a nursing home outbreak, with most new cases arising on the memory-care unit.
This strategy prioritizes isolating exposed individuals when individual rooms are scarce.
Key findings
01Initial point-prevalence testing of 120 residents identified 77 positive and 43 negative-exposed individuals, establishing the initial cohorts.
02Of the 12 residents who converted to positive on repeat testing, 10 were on the memory-care unit, highlighting the high risk in dementia care areas.
03The three-tiered cohorting approach is proposed to separate exposed from unexposed negative-test individuals to stop horizontal transmission among older adults with dementia.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The strategy was piloted at a single institution, limiting generalizability. Staff compliance with personal protective equipment (PPE) was not evaluated. Extended use of PPE was practiced due to shortages, which may have affected transmission dynamics. Universal testing of staff was not performed, so asymptomatic transmission from staff cannot be ruled out. The long-term sustainability and necessity of continued prevalence testing were not evaluated. The authors state that strong evidence regarding the efficacy or effectiveness of this specific cohorting innovation does not yet exist.
Declared interests
The study was supported by the U.S. Public Health Service. The authors declare no other conflicts of interest.
The easy way to misread this
Do not interpret this as proof that the cohorting strategy alone prevented all transmission, as the study lacked a control group and did not evaluate staff compliance or PPE shortages. The authors explicitly state that strong evidence for efficacy does not yet exist and that outcomes cannot be assured.