Experiences of frontline workers during COVID-19 outbreaks in long-term care, and evaluation of interventions to reduce transmission in long-term care

Brandon Yau and Rohit Vijh, MPH (2021) and PHPM Residents

Graduate students across all educational programs at the School of Population and Public Health (SPPH) are working on diverse and important public health issues. In our new series, we will be hearing directly from current students and recent graduates about what they are working on, why it matters, and how their training at SPPH has prepared them to meet the research and professional challenges of tomorrow.

Brandon Yau

Rohit Vijh

Tell us about your recent publications. 

BY: Our research project was developed while on a public health rotation at Vancouver Coastal Health. We were managing outbreaks of COVID-19 in long-term care facilities in the region and we felt there would be an opportunity for a quality improvement project related to the management of outbreaks in these settings.

There is a lack of research on key factors associated with outbreak management and we felt that frontline workers with direct experience managing these outbreaks could provide invaluable insight. Our goals included: describing the experiences of these frontline workers, identifying best practices and areas improvement in outbreak management, and to provide actionable recommendations on improving the management of COVID-19 outbreaks.

Our research uncovered gaps in outbreak management in some facilities which included: challenges in identifying and testing residents, gaps in infection control support and training, access to and appropriate use of PPE, problematic work environments and management styles, poor communication between various teams, and staffing challenges. Areas of best practice included robust testing strategies for residents and staff, additional infection prevention and control training and support, and strong commitment to patient care by frontline staff.

RV: Our research provided more robust evidence in supporting the strategy that Vancouver Coastal Health had employed in managing these Long-Term Care (LTC) outbreaks. There were however many limitations to the study was it evaluated the entire gamut of measures delivered and so our qualitative study sought to understand the complexities and challenges of these public health measures in greater detail. These two papers represent the utility of using a mixed-methods approach to understand complex questions such as this one.

You can read the full publications here and here.

How would you like to see this work implemented? 

BY: There are many practical implications of the research findings. The key recommendations illustrated in the article include: 1) Maintaining vigilance for COVID-19 in long-term care facilities, 2) Providing regular, ongoing, and comprehensive infection prevention and control training and education to staff in long-term care, and 3) Developing formal mechanisms for communication and coordination between the various groups involved in outbreak management.

Provincial reviews of the long-term care sector have been proposed, which will uncover many of the longstanding issues identified in this article and others. In a broader sense, we hope our findings contribute to meaningful policy changes to how the long-term care sector in Canada is funded, staffed, and managed in the future.

RV: We also hope that many of our findings will help inform and prepare LTC for future outbreaks and ultimately be part of standard pandemic planning at the end of the global pandemic. 

What sparked your interest in this subject?

BY: Our interest in researching this topic arose from a very practical need to conduct a quality improvement assessment of an area of work in public health in response to an emerging pathogen.

Personally, I was interested in this work because of the disproportionate impact COVID-19 was having on our elders and the frontline workers caring for them. I was interested in giving voice to these frontline workers facing some of the most challenging working conditions in our healthcare system and to highlight some of the systematic problems within the long-term care sector.

RV: I think at the outset of the pandemic in 2020, long term care facilities were disproportionately affected by COVID-19. Our work helped inform in real time the actions and adjustments made by public health during the course of these outbreaks. We knew that being able to conduct a comprehensive evaluation would be imperative to better control these outbreaks and ultimately prevent infections and deaths.

You can follow Brandon on Twitter at @BrandonYVR, Rohit at @RVijh, and the PHPM Residents at @UBC_PHPM