Clusters at nursing homes What happened to corona infections? What are the challenges?

Clusters at nursing homes What happened to corona infections? What are the challenges? July 20, 17:40

As the new coronavirus infection spreads again, mass infections are occurring one after another at "nursing homes" used by elderly people who are at high risk of getting serious.

Of these, at Higurashi no Sato, a nursing home for the elderly in Tokyo's Arakawa Ward, by the 15th of this month, a total of 32 people, including 25 residents and 7 staff members, had been infected.

In addition, at Adachi Care Community Soyokaze, an outpatient care facility in Adachi-ku, Tokyo, 30 people, including users and staff, were confirmed to be infected by the 18th.

In addition to Tokyo, five people, including residents and staff, were confirmed to be infected at a special elderly nursing home "Matsudo Yodarikan" in Matsudo City, Chiba Prefecture by 11th of this month. By the 19th, the facility "Himawari no Sato Yoshii" has been confirmed to have been infected by 8 people, including staff and users.

According to the Ministry of Health, Labor and Welfare, outbreaks have been reported in at least 47 nursing homes nationwide, including during the first wave. The elderly are at high risk of becoming seriously ill, and the Ministry of Health, Labor and Welfare has called on nursing homes to "check carefully what to do if an infected person comes out and proceed with preparations."

What happened?

Among nursing homes where a mass infection was confirmed, a nursing home for the elderly in Matsudo City, Chiba Prefecture, interviewed NHK.

By the 11th of this month, the special elderly nursing home "Matsudo Yodarikan" was confirmed to have infected 5 people, including 2 residents and 3 staff members. Chiba Prefecture announced that a cluster had occurred. How did the infection spread as each facility became more alert after the first wave?

According to the social welfare corporation that operates the facility, the first confirmed infection was a male employee in his thirties on June 29. The route of infection is unknown, and it is suspected that the infection occurred in the city.

Two days later (July 1st), another staff member who was taking bathing assistance for the user with a male staff member and a female member in the 90s who was on the floor where this staff member worked Two people were confirmed infected.

The facility positions the floor on which the resident is located as a “red zone” where there is a high risk of infection, prevents the resident from contacting people on other floors, and makes sure that staff members wear protective equipment such as gowns and goggles. We tried to prevent the spread of infection.

As a result, no infected person came out of another floor, but on the 6th of this month, a woman in her 80s living on the same floor, and on the 10th, a male employee who was in support of this floor was confirmed infected. It was.

Of the five people who were confirmed infected, all three were already discharged from the hospital, and two were still hospitalized, but no one had severe symptoms.

Tetsuyuki Kimura, the head of the social welfare corporation that manages the facility, said, "The staff were living with care so that they would not bring the virus into the facility, but it seemed that the coronavirus had suddenly creeped up at their feet. We took as much measures as possible, such as performing zoning at an early stage to prevent the spread of infection at the facility."

What are the challenges?

As I further gathered information, it became clear that the nursing home for the elderly in Matsudo City was facing some challenges in dealing with it.

1 No PCR test allowed for all

One of them is "inspection". When the infection of a male employee was first revealed, the facility asked the public health center to perform PCR on more than 160 people including all residents and staff.

However, the public health center targeted about 30 people including the residents and staff members on the floor where male staff were in charge.

On the other hand, staff members who were not included in the inspection raised concerns. It is said that some of the family members who lived together had senior citizens who stayed in beds or cars set up in the hallway without returning home.

After that, the facility negotiated with the city and the testing center established by the medical association, and finally the inspection of all was realized, but two weeks had passed since the first infected person was confirmed.

No one tested positive, but the social welfare corporation that manages the facility wants the government and the government to broaden the scope of the test as much as possible so that employees can work with peace of mind.

We also faced challenges when performing PCR tests.

The doctor who collects the sample from the public health center was instructed to search for it.

It is said that the contract doctors who usually have medical examinations at the facility were on standby at home and could not find a doctor who could respond immediately.

2 I cannot be hospitalized immediately

Another major issue was the inability to immediately hospitalize infected people.

On the 1st of this month, when it was confirmed that the third female in her 90s was infected at the facility, the hospital to accept was not immediately decided, and the woman had to spend the night in the facility. did. The public health center proceeded with the adjustment, and the facility asked a nearby hospital to accept it, but it was not immediately found.

The facility urgently increased the number of night shift staff to respond.

It is not known whether the infection has spread due to the lack of immediate hospitalization, but the facility is requesting hospitalization as soon as possible because the elderly are at high risk of becoming more severe.

Tetsuyuki Kimura, head of the social welfare corporation that manages the facility, said, “When one person is infected, it is of utmost importance to stop the spread of infection within the facility. I would like you to consider a mechanism that can be implemented promptly.”

Expert "Prompt hospitalization and thorough examination"

In the first wave of mass infections in nursing homes all over the country, there were cases in which it was pointed out that hospitalization of infected people and examinations of the inpatients did not proceed smoothly, resulting in the spread of infection.

Yasuhiro Yuki, a professor at Shutoku University who is familiar with nursing care administration, said, "No matter how thorough measures are taken to prevent the virus from being brought into the facility, staff members may get infected in the city. How can an infected person come out? It is important to prevent the expansion at an early stage, and prompt hospitalization and thorough examination are the minimum measures."

In addition, "There are few medical institutions that can support nursing care, and it is assumed that elderly infected people may be refused hospitalization, so we will expand the number of people who can support nursing care at the medical site as soon as possible, We should develop accommodation and medical facilities that support nursing care."

The correspondence of Chiba Prefecture

Regarding the response to the outbreak of nursing homes in Matsudo City, Chiba Prefecture said, "There was no problem in the prefecture's response, but we would like to continue to listen to the stories from a wide range of facility personnel and take serious measures. ".

First of all, regarding the PCR test, we did not immediately test all the residents and staff, but in Chiba prefecture, nurses specializing in infectious diseases entered the facility many times and inspected concentrated contacts As a result of carrying out all the "safety" tests, we were able to identify all infected people by the prefecture's tests."

He added that the inspection targets needed to be prioritized and said, "The prefecture is not able to inspect for "safety" at the moment, but if there is a new notification from the national government that it should be expanded, Will be implemented."

Regarding securing doctors to collect samples for PCR test, in addition to having two contract doctors registered at the facility and there were medical institutions that cooperated, the doctors could be found on the facility side as a result of discussion. I was thinking.

This time, "I think that if there was a consultation that I could not find it by all means, I thought that I responded at the public health center, but I did not realize that it was so difficult to secure a doctor so much" Since there is a doctor who manages the health of the residents, it is smoother for the doctor who usually examines to deal with people with dementia such as this time, so in principle, we want you to secure it yourself. "

Regarding the indication that the infected person could not be hospitalized immediately, Chiba Prefecture said, "Because there are preparations for the receiving side and arrangements for a car to transport, it may be unavoidable that it takes one or two days to be hospitalized. In addition, the test result for this case was found in the afternoon and was accepted at the hospital the next day, so "this time it was a case where hospitalization could be adjusted smoothly."

In addition, regarding the response of the cluster this time, it was the recognition that “it was able to support goods and dispatch experts a number of times, and the prefecture was able to hold it down to 5 people.” We would like to conduct a wide-ranging hearing about what kind of response we are looking for and at the same time put efforts into disseminating measures to prevent the spread of infection once an infected person appears."