Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study



Tulloch, John SP ORCID: 0000-0003-2150-0090, Micocci, Massimo, Buckle, Peter, Lawrenson, Karen, Kierkegaard, Patrick, McLister, Anna, Gordon, Adam L, Garcia-Finana, Marta ORCID: 0000-0003-4939-0575, Peddie, Steve, Ashton, Matthew
et al (show 2 more authors) (2021) Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study. AGE AND AGEING, 50 (6). pp. 1868-1875.

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Abstract

<h4>Introduction</h4>Care homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs).<h4>Methods</h4>An evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation.<h4>Results</h4>In total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving $\ge$50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing.<h4>Conclusion</h4>Implementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence.

Item Type: Article
Uncontrolled Keywords: lateral flow devices, antigen test, SARS-CoV-2, care homes, COVID-19, rapid point-of-care testing
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 06 Jul 2021 07:18
Last Modified: 19 Jan 2023 15:33
DOI: 10.1093/ageing/afab162
Open Access URL: https://doi.org/10.1093/ageing/afab162
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3128905