A mixed methods study into COVID-19 and influenza outbreak management in nursing homes: The challenge of seeking balance between infection prevention and well-being

Objectives: Throughout the COVID-19 pandemic, public debate arose regarding the proportionality of infection prevention and control (IPC) measures in nursing homes (NHs), as these measures negatively impacted residents' well-being. To be better prepared for future outbreaks and pandemics, we need a deeper understanding of how NHs manage COVID-19 or influenza outbreaks, and which considerations are being made to balance IPC and well-being.

Design: Mixed-methods study.

Setting and Participants: Fourteen Dutch NH organizations (176 NH locations) where COVID-19 or influenza outbreaks occurred during winter 2022-2023 were included.

Methods: We monitored the progression and management of 24 outbreaks by administering weekly questionnaires. Heterogeneous sampling was used to select 7 outbreaks for extensive monitoring, including epidemiologic data collection on the resident level and outbreak management evaluation through qualitative interviews (n = 7). Quantitative data were used for descriptive analysis (all outbreaks) and the generation of epidemiologic curves (extensively monitored outbreaks). Qualitative interview data were used to deepen our understanding of the considerations and adjustments made to IPC strategies by NH staff.

Results: We observed differences in IPC measures taken between NH organizations, but also within NH organizations, as IPC protocols were often customized to fit specific units, residents, or situations during outbreaks. Staff consistently considered the impact of IPC measures on residents against their beliefs about the effectiveness of measures, which occasionally led them to deviate from their IPC strategy in favor of residents' well-being.

Conclusion and Implications: The current study provides an understanding of how COVID-19 and influenza outbreaks were managed, how NH staff considered the impact and effectiveness of measures, and consequently, how IPC strategies were gradually adjusted during outbreaks. Acknowledging that although the majority of NH staff consistently recognize the need to tailor IPC measures, they inconsistently apply such customization in practice, which may help NH organizations better prepare for future outbreaks.