Education And Training For Infection Prevention And Control Provided By Long-term Care Homes To Family Caregivers: A Scoping Review Protocol

MacLean, Rachel¹; Durepos, Pamela¹; Gibbons, Caroline²; Morris, Patricia^1,3; Witherspoon, Richelle⁴; Taylor, Natasha⁵; Keeping-Burke, Lisa^5,6; McCloskey, Rose^5,6Author Information

JBI Evidence Synthesis ():10.11124/JBIES-22-00308, January 18, 2023. | DOI: 10.11124/JBIES-22-00308

Abstract

Objective: 

The objective of this review is to map the infection prevention and control education and training that long-term care homes use with families during a pandemic or infectious outbreak.

Introduction: 

During the COVID-19 pandemic, restrictions were imposed on visits to long-term care homes to decrease the risk of virus transmission. These restrictions had negative consequences for both residents and families. A scoping review of infection prevention and control education and training used with families will inform family visitation practices and policies during future infectious outbreaks.

Inclusion Criteria: 

This review will examine literature describing infection prevention and control education and training provided to families in long-term care homes. Research and narrative papers, including experimental, quasi-experimental, descriptive observational quantitative and qualitative studies, reviews, text, policy, and opinion papers, will be considered for inclusion.

Methods: 

A 3-step approach will be followed, in line with the JBI methodology for scoping reviews. Published literature will be searched for in databases including CINAHL, Embase, ERIC, MEDLINE, and AgeLine. Published and unpublished papers will be considered from 1990 to the present, in English or in French. The World Health Organization, Centers for Disease Control, and the Public Health Agency of Canada websites will be searched for unpublished and gray literature. Two authors will independently review and assess studies for inclusion and extract the data. The findings will be charted in a narrative summary and tables.

Introduction

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic as the virus spread rapidly through more than 114 countries around the world.¹ This proclamation heightened the need for infection prevention and control (IPC) procedures in nearly every sector of society, but particularly for vulnerable populations, such as those residing in long-term care (LTC) homes (ie, residential and skilled nursing homes).² Concerns over the rapid spread of the virus prompted governments and LTC institutions across the globe to take immediate and unprecedented actions, including declarations of states of emergency as well as nationwide and institutional lockdowns.^3–5 Many international LTC homes closed to nonessential workers and family and friends of residents.⁶ Even in the absence of local COVID-19 outbreaks, a key IPC strategy in many jurisdictions during the early phases of the pandemic was to prohibit visitors (ie, residents’ family and friends), along with other recreational opportunities that were deemed nonessential.^7,8

Concerns about the impact of COVID-19 were legitimized within the first 6 months of the pandemic, with more than 50% of COVID-19 deaths in many countries occurring in LTC homes, including in Canada, Ireland, Israel, Norway, and Spain.⁹ Canada’s LTC homes were hit particularly hard, with 81% of COVID-19 deaths within the first 6 months occurring in LTC homes.⁹ Emerging evidence points to the devastating effects of IPC measures, such as visitor restriction policies, on residents’ quality of life and well-being. These restrictions resulted in increased rates of depression, social isolation, agitation, and diminished quality of life and well-being amongst residents.^10,11 One population-based study reported an increase in the proportion of residents prescribed antidepressants and antipsychotic medication during the first 7 months of the pandemic.¹² A number of qualitative investigations reported substantial stress for families with limited opportunities for social engagement with residents, exclusion from regular routines, and changes in identity as caregiver roles were altered or dismissed.^10,13–15 This large and growing body of literature increased awareness of the negative consequences of visitor restrictions on the physical and psychosocial health and well-being of both LTC home residents and their families.^12,16 Awareness of the impact of countermeasures to mitigate the risk of COVID-19 also raises questions about LTC homes’ responses to other infectious outbreaks, both pre- and post-pandemic.¹⁷

As the pandemic evolved, many governments and agencies revaluated the role of families within LTC, recognizing them as essential care partners, and as a result, visitation restrictions were eased.¹⁸ However, although families are essential to residents’ health and well-being, they are also acknowledged as potential sources of infection. Therefore, simply allowing families back into LTC homes without an adequate strategy to prevent COVID-19 from entering or spreading throughout homes was never an option.¹ Reopening guidelines were soon released in many jurisdictions, outlining conditions for families to reenter LTC homes. These guidelines contained varying recommendations^19,24 in terms of location where visits could occur,²⁰ the need for adequate supply of personal protective equipment,⁶ and minimum COVID-19 infection rates, both within the LTC home and the local community, for visits to be maintained.⁶

Conditions present in virtually all guidelines were the screening of visitors for COVID-19 and education and training of visitors on IPC practices.^7,21–23 Education and training of families included information on how and when to wash hands, chain of infection, use of personal protective equipment, and recognizing signs of infection. Such education and training guidelines considered the risks of COVID-19 and other infections within the context of residents’ and families’ physical and psychosocial well-being.¹² The variations that exist in guidelines reflect a lack of standardization in how LTC homes approach IPC education and training for family caregivers. Even beyond COVID-19, the pandemic has highlighted the importance of standardized IPC guidelines in LTC homes, including those that specifically target families.

Stall et al.,¹² among others,^24,25 stressed that family visitation guidelines during any infectious outbreak need to be equitable and reflect both compassion and flexibility. At the same time, calls persists to prioritize resident and staff safety during family visits through appropriate measures to minimize the risk of families transferring COVID-19.²⁴ Balancing the protection of residents and reestablishing visits is a challenge, particularly because efforts to support visits must take into account the physical characteristics of individual homes as well as the demographic profile of residents and family caregivers (eg, physical and cognitive abilities and limitations).¹²

Stall et al.¹² offered guiding principles that individual LTC homes should consider when devising their own strategies to support visits during actual or potential infectious outbreaks. These principles include i) differentiating between family caregivers (who may have direct contact with residents) and visitors (who may be volunteers and not have direct contact with residents); ii) balancing residents’ risk of potential contact with COVID-19 with the risk of social isolation and diminished quality of life; iii) prioritizing access equity (each resident provided the appropriate level of access to maintain health and well-being) over equality (all residents having the same access); iv) transparency and ongoing communication with all stakeholders about family access to residents; v) collecting data and reporting on COVID-19 cases as this pertains to reopening to visitors; and vi) mechanisms for families and visitors to provide feedback and appeal institutional practices around visitation.¹² Similarly, the WHO²⁶ provides guidance on how to support visitations in health facilities; however, these recommendations are not directed specifically at the high-risk LTC population nor do they mention IPC education and training in LTC homes.

Without clear recommendations, decisions about how to prepare families to safely visit LTC homes have been left to individual homes. Because there is strong evidence supporting the essential role families play in residents’ health and well-being, it is important to identify, describe, and share education and training strategies that LTC homes have successfully developed and implemented to promote safe family visits during the COVID-19 pandemic and other infectious outbreaks. This information will provide an in-depth understanding of the scope of education and training available, which we will disseminate locally, nationally, and internationally to LTC homes seeking to establish IPC strategies for families. Depending on the types of evidence uncovered, this review may also identify the need for future research and/or reviews on IPC strategies that target families. While our interest is in safe visitation during the COVID-19 pandemic, IPC education and training provided to families during other outbreaks, such as influenza, are relevant. Further, even in the absence of a pandemic, the need for family education and training is important in LTC homes.

A preliminary search of Embase, ERIC, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted on June 30, 2022, and no current or underway systematic reviews or scoping reviews on the topic were identified. The aim of this scoping review will be to map the available evidence, guidelines, practices, and policies on IPC education and training provided to family caregivers of LTC residents, and what, when, and how this is provided. The review will serve as a comprehensive source of information for policymakers and LTC homes tasked with developing visitation practices, polices, or standards. The findings of this review will also help to identify areas of future research and may ultimately assist in developing universal standards for visitation in LTC homes during infectious disease outbreaks.

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January 18, 2023. Article by, MacLean, Rachel¹; Durepos, Pamela¹; Gibbons, Caroline²; Morris, Patricia^1,3; Witherspoon, Richelle⁴; Taylor, Natasha⁵; Keeping-Burke, Lisa^5,6; McCloskey, Rose^5,6