Infection control challenges during 4 years of COVID-19 in a French psychiatric institution (2020-2024)

The COVID-19 pandemic posed unprecedented infection control challenges for psychiatric facilities.

We examined 4-year COVID-19 infection control challenges in acute psychiatric care (general adult, closed, adolescent, and psychogeriatric units) and residential psychiatric care (medicalized and specialized facilities) from week 11 of 2020 to week 20 of 2024. Reverse transcription-polymerase chain reaction and antigen rapid diagnostic tests (Ag-RDTs) were analyzed according to admission timing, age, sex, wave patterns, care settings, and outbreaks.

Of the 6552 reverse transcription-polymerase chain reaction tests and 3314 Ag-RDTs, 502 (7.7%) and 38 (1.1%) were positive, respectively. In the multivariable analysis adjusted for age, sex, and care setting, increasing age and admission to closed units were independently associated with SARS-CoV-2 positivity, whereas the psychogeriatric setting was not. Outbreak investigations accounted for 361 (66.9%) cases, whereas 179 (33.1%) were non-outbreak cases. Psychogeriatric units were the most affected (median of four outbreaks per unit), compared with three in closed units; two in adolescent, general adult, and medicalized care units; and one in specialized care units (P = 0.01). Outbreak infection rates were lower in general adult (25.0%, N = 193) and medicalized care units (28.6%, N = 127) and higher in adolescent (76.9%, N = 21), specialized (72.5%, N = 78), and psychogeriatric units (50.0%, N = 225) (P <0.01), with closed units showing intermediate rates (39.0%, N = 244).

Nosocomial COVID-19 is common in psychiatric settings, and effective risk management strategies for airborne diseases must be tailored to psychiatric care settings, patient behaviors, and rapid control measures.