Life In The Slower Lane

Here is the structured PICO analysis for the ninth article you uploaded:

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Full Title (verbatim and exact):

“Factors impacting resident outcomes from COVID-19 outbreaks in Residential Aged Care Facilities in Sydney Local Health District: testing an infection prevention and control scoring system”

Stubbs A, Dawson E, Campbell E, et al.

BMC Public Health 2023; 23:1763

DOI: https://doi.org/10.1186/s12889-023-16634-3

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Type of Article:

Retrospective observational cohort study

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PICO Analysis:

Population:

• Residents of Residential Aged Care Facilities (RACFs) in Sydney Local Health District (SLHD), New South Wales, Australia
• All 56 RACFs in SLHD were considered, with 55 facilities included in the final analysis
• Study period: June 2021 to February 2022, covering Delta and Omicron COVID-19 waves 

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Intervention:

• Development and application of a novel Infection Prevention and Control (IPC) scoring system, measuring:
  • Facility layout and cohorting capability
  • IPC practices in each facility zone
  • Personal protective equipment (PPE), hand hygiene, cleaning, ventilation, and staffing
• A second Management scoring system evaluated perceived quality of facility leadership and preparedness 

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Comparator:

• No formal control group. Facilities were compared by IPC score tertiles:
  • <60% (reference group)
  • 60–75%
  • 75%

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Outcome:

1. Person-centred outcomes:

• Resident attack rate: proportion of residents infected during the outbreak
• Resident mortality rate: proportion of COVID-19 related deaths during the outbreak 

2. Process outcomes:

• Not the focus of this study, but facility-level IPC practices and readiness were evaluated as exposure variables

3. Health system outcomes:

• Association between IPC score and outcomes:
  • Facilities with IPC scores >75% had:
    • 19.6% higher attack rates (95% CI: 6.4–32.8)
    • 1.7% higher mortality rates (95% CI: 0.7–2.7) compared to <60% IPC score facilities
• Single-room occupancy associated with lower mortality:
  • 1.4% lower mortality when ≥50% of residents had single rooms
• No significant relationship found between Management score and outcomes 

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Summary Conclusion:

The study introduced a novel IPC scoring system for RACFs and demonstrated its utility in predicting adverse outcomes during COVID-19 outbreaks. Higher IPC scores—indicating more IPC-related risk factors—were strongly associated with higher attack and mortality rates. The study did not find evidence that management quality (as scored) was predictive of outcomes. This IPC tool could inform future preparedness assessments and targeted outbreak responses in aged care facilities.

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