Design interventions to support IPAC in LTC
Canada’s Long-Term Care (LTC) sector has been disproportionately burdened by COVID-19, accounting for 85% of all COVID‑19 deaths nationwide. LTC residents are particularly vulnerable given their advanced age, reduced immune system capacity and multiple underlying health conditions. But LTC staff have also faced an increased risk of infection due to frequent multi-site work coupled with personal protective equipment (PPE) shortages in work environments that may not support infection prevention and control (IPAC). As a result, LTC staff members represent over 10% of confirmed COVID‑19 cases in Canada (as of May 25), with nine reported deaths. Given the frequent close contact between LTC staff and residents, preventing infection among staff has, and will continue to be, an important infection control strategy to reduce further morbidity and mortality among LTC residents and staff while ensuring quality and continuity of care. Existing IPAC protocols designed to help mitigate the risks of staff-to-staff transmission in shared settings are often based on acute care environments and may not ‘fit’ or support the unique characteristics of LTC, which include: a variety of shared working and respite spaces; spaces which are detailed to be home-like and may in turn be difficult to clean or disinfect; crowding in small staffing areas which weren’t designed to support physical distancing; dynamic traffic in shared spaces; open shared spaces which may be difficult to monitor access or inadvertent contamination due to open access; and the organic flow of staff, allied health, contractors, residents, family and friends entering and leaving the home and moving throughout the home, to name just a few considerations. Since March 2020, IPAC protocols had to be rapidly developed, deployed and learned in LTC to respond to the pandemic. The critical nature of this fast-evolving situation, coupled with a lack of information on the impact of such protocols within the context of actual use patterns and behaviours in shared spaces, highlights the urgency of improving our understanding of factors that may influence transmission risks between LTC staff, and in turn the wellbeing of LTC residents, family members and friends. This knowledge is required to improve our ability to modify, renovate and design LTC and senior’s homes to be more resilient in the face of infectious outbreaks while maintaining their friendly, residential, people-centred characteristics. Within this context, we want to support homes by studying: 1) How the design of shared staff spaces (or lack thereof) and staff use patterns may be undermining IPAC; 2) What rapid and low-cost design interventions may help reduce such risk factors?; 3) In what ways might our design interventions reduce these risk factors?; and 4) What is the cost and cost-effectiveness of the proposed interventions?