Table 4.

Staff-specific outcomes of strategies to reduce transmission

Study	Interventions	Prevalence	Mortality	Other outcomes
Arons et al18	Mass testing PPE	26/51 (51.0%) 17/26 (65%) were nursing staff, 9/26 (35%) had roles that provided care/therapies across multiple units		0/26 hospitalised
Blackman et al19	PPE Symptom screening Visitor restrictions			26 staff members absent from work due to sickness
Borras-Bermejo et al54	Mass testing Visitor restrictions	403/2655 (15.2%), 144/403 (35.7%) asymptomatic		1772/2665 (66.7%) staff reported fever or respiratory symptoms in the preceding 14 days
Dora et al20	Mass testing (three point-prevalence surveys) Symptom screening Visitor restrictions Hand hygiene, contact precautions Cohorting	8/136 (6%) 4/8 (50%) asymptomatic 3/8 nursing staff 5/8 licensed vocational nurses
Dutey-Magni et al39	Mass testing	585/11604 (5.0%)		1892/11604 (16.3%) reported symptoms
Eckardt et al21	Mass testing (three point-prevalence surveys) PPE Symptom screening Visitor restrictions Cohorting	Survey 1: 10/176 (5.7%), 10/10 (100%) asymptomatic Survey 2: 5/175 (2.9%), 5/5 (100%) asymptomatic Survey 3: 1/173 (0.6%), 1/1 (100%) asymptomatic
Feaster and Goh22	Mass testing	223/356 (62.6%), 55/223 (24.7%) asymptomatic		Infection prevalence higher in staff with direct resident contact (150/219, 68.5%) compared with staff with no direct resident contact (25/52, 48.1%)
Fisman et al43	Facility characteristics			Infection among LTCF staff was associated with death among residents with a 6-day lag (adjusted IRR for death per infected staff member, 1.17; 95% CI 1.11 to 1.26) and a 2-day lag (relative increase in risk of death per staff member with infection, 1.20; 95% CI 1.14 to 1.26)
Graham et al23	Mass testing (two point-prevalence surveys) Cohorting	3/70 (4.3%) 3/3 (100%) asymptomatic		Staff absence due to sickness/self-isolation between 1 March and 1 May elevated relative to background level (215.9% increase, 95% CI 80 to 352)
Guery et al45	Mass testing	3/136 (2.2%) 1/3 (33.3%) asymptomatic 1/3 (33.3%) presymptomatic 1/3 (33.3%) symptomatic
Harris et al25	Facility characteristics	7 staff COVID-19 positive prior to intervention 0 further staff positive after intervention implemented
Heung et al47	Hand hygiene, contact precautions	1 staff member SARS-CoV positive during outbreak (a domestic worker) 0/26 staff positive for SARS-CoV antibodies
Ho et al48	PPE Cohorting	1 staff member SARS positive	1/1 (100%)
Hoxha et al49	Mass testing	2953/138327 (2.1%) 2185/2953 (74.0%) asymptomatic
Kennelly et al51	Mass testing Facility characteristics	675 staff COVID-19 positive 159/675 (23.6%) asymptomatic		Proportion of symptomatic staff correlated with number of residents with confirmed/suspected COVID-19, ρ=0.81 (p<0.001)
Lennon et al27	Mass testing	624/15514 (4.1%) 487/624 (78.0%) asymptomatic 40/624 (6.4%) symptomatic
Louie et al28	Mass testing Symptom screening Visitor restrictions	214/431 (49.7%) residents and staff COVID-19 positive 86/214 asymptomatic 128/214 symptomatic (50/128 were healthcare workers) Additional asymptomatic staff testing: 23/147 (15.6%) staff COVID-19 positive		0/50 symptomatic healthcare workers hospitalised
McMichael et al29	Mass testing PPE Cohorting	50 staff COVID-19 positive	0/50 (0%)	3/50 (6%) hospitalised Staff roles for confirmed cases: therapists, nurses, nurse assistants, health information manager, physician, case manager
Office for National Statistics40	Mass testing Facility characteristics	Estimated 6.9% (95% CI 5.9% to 7.9%) staff COVID-19 positive across homes that reported an outbreak		Odds of staff infection: for each additional infected resident, staff infection OR=1.04 (95% CI 1.04 to 1.04) Care homes using bank or agency staff most or every day OR=1.88 (95% CI 1.77 to 2.0) compared with homes not using these staff Homes where staff work in other homes most or every day OR=2.4 (95% CI 1.92 to 3.0) compared with homes where staff never work elsewhere Staff at homes outside London had higher odds of COVID-19 infection
Patel et al30	Mass testing Symptom screening Visitor restrictions Cohorting	19/42 (45.2%) 11/19 symptomatic (57.9%) 8/19 (42.1%) asymptomatic
Quicke et al31	Mass testing (five point-prevalence surveys)	Site A: all staff uninfected Site B: low prevalence in week 1, weeks 2–5 no infections detected, week 6 increase in cases Site C: initial infection prevalence was lower (6.9%), and the incidence declined to zero by week 3 Site D: 22.5% of workers at site D had prevalent infections at the start of the study and incidence was high initially (12.2 per 100 workers per week), declining over time Site E: low prevalence in week 1 saw an increase in cases in subsequent weeks
Roxby et al33	Mass testing Symptom screening Visitor restrictions Hand hygiene, contact precautions Cohorting	2/62 (3.2%) (1 worked in dining facilities, 1 was a health aide) 2/2 (100%) symptomatic
Sacco et al46	Mass testing PPE Visitor restrictions Hand hygiene, contact precautions Cohorting	22 staff COVID-19 positive 9/22 (40.1%) asymptomatic	0/22 (0%)	Staff incidence: care givers=0.48/100 person-days Non-care givers with resident contact=0.36/100 person-days Non-care givers with no resident contact=0.04/100 person-days
Stall et al44	Facility characteristics			Outbreak involving staff and residents' for-profit homes 59/360 and staff only 44/360 Non-profit homes staff only 18/162. Municipal homes=outbreak staff only 16/101
Telford et al35	Mass testing (15 facilities in response to outbreak, 13 facilities as prevention)	264/2803 (9.4%) Response group: 249/264 (94.3%) Preventive group: 15/264 (5.7%) (d) Prevalence: response group 12.8% vs preventive group 1.7%, p<0.0001	1/264 (0.4%) Response group: 0/249 (0%) Preventive group: 1/15 (6.7%)	16/264 (6.1%) hospitalised Response group: 15/249 (6.0%) hospitalised Preventive group: 1/15 (6.7%) hospitalised 15/249

IRR, incidence risk ratio; LTCF, long-term care facility.