Infection-Control Protocol Acceptability in Skilled Nursing Facilities During the COVID-19 Pandemic

To assess the acceptability of an infection-control prevention strategy during the COVID-19 pandemic for skilled nursing facilities (SNFs) staff and residents, to describe implementation challenges and potential solutions, and to explore intervention impact perceptions.

Qualitative investigation of a multimethod pragmatic clinical trial designed to develop and test a novel cohorting intervention to mitigate infection transmission in SNFs during the COVID-19 pandemic.

We used a purposive sample of staff and residents in 2 New York City nonprofit SNFs participating in the intervention trial.

We developed a novel cohorting strategy to minimize infection transmission by using infection risk (vaccination or prior infection history) to assign staff to specific residents. We employed a qualitative descriptive approach using content thematic analysis of semistructured interviews with staff and residents to identify themes of acceptability, challenges, and potential impact.

Seventy-one staff and 16 residents completed semistructured interviews. Staff and residents supported the intervention. However, both identified challenges, including concerns that switching assignments could lead to staffing issues and care discontinuity. Staff identified communication about the intervention as both a challenge and potential solution, citing a desire for clear and consistent communication across all employees. Staff felt the intervention had potential impact in reducing infection risk fear, promoting effective protective equipment usage, and encouraging more interaction and less isolation than standard prevention practices.

We developed a novel and acceptable preventive strategy that may increase residents' flexibility and reduce their isolation as well as staff stress. Clear, consistent, and proactive communication may improve intervention acceptability and perceptions about impact. Similar infection-control protocols might be adapted for different long-term care infection risks. Communication at all staffing levels and with residents is essential to ensure the intervention is acceptable to both. Future trials could include social isolation and staff burnout as potential outcomes.