Surveillance of lower respiratory tract infections within UK care homes, in the context of the SARS-CoV-2 pandemic.

Abstract

Outbreaks of respiratory infections are common in care homes, with severe
consequences for frail residents. The COVID-19 pandemic highlighted a need for better infection prevention and control (IPC) in care homes, including surveillance to identify infections early and prevent transmission. This thesis outlines why and how we conduct surveillance for respiratory infections in care homes, then explores the value of enhanced testing and novel approaches to surveillance that were implemented during the pandemic.

It can be difficult to identify respiratory infections in care homes; among a cohort of people hospitalised with Lower Respiratory Tract Infection (LRTI) I found that older adults (>=65 years) were significantly less likely than younger adults to meet a standard definition of LRTI based on their symptoms. Frequent testing during the pandemic helped to increase infection ascertainment and meant that I was able to compare trends in the frequency of care home outbreaks and incidence of SARS-CoV-2 infection in the community. Time series analysis showed that outbreak activity in care homes mirrored infection incidence in the wider population, in spite of measures to shield care home populations from the virus. Repeated nose/ throat swabbing is unpleasant, so I
piloted non-invasive sampling methods for detecting SARS-CoV-2 in care homes. Both indoor surface swabbing and sewage sampling identified traces of the virus, though it was not possible to ascertain their exact source.

The pandemic caused a surge in surveillance activity in care homes, and in the UK new sentinel systems have emerged to generate information about infections in care homes. As these systems grow, I argue that there is an opportunity to reflect on the risks that public health surveillance poses to group privacy in care homes, and work to mitigate these risks by allowing residents and staff to decide how their data are collected and used.

Date of Award	4 Feb 2025
Original language	English
Awarding Institution	University of Bristol
Supervisor	Matt Hickman (Supervisor), Derren R Ready (Supervisor), Leon Danon (Supervisor) & Andrew Singer (Supervisor)