{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:06:52Z","timestamp":1784308012815,"version":"3.55.0"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X20013756_as1\"><jats:title>Objective:<\/jats:title><jats:p>To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled-nursing facility (SNF), and the strategies that controlled transmission.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20013756_as2\"><jats:title>Design, setting, and participants:<\/jats:title><jats:p>This cohort study was conducted during March 22\u2013May 4, 2020, among all staff and residents at a 780-bed SNF in San Francisco, California.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20013756_as3\"><jats:title>Methods:<\/jats:title><jats:p>Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPSs) in units with confirmed cases. Cases were confirmed by real-time reverse transcription\u2013polymerase chain reaction testing for SARS-CoV-2, and whole-genome sequencing (WGS) was used to characterize viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact with a confirmed case; restricting movement between units; implementing surgical face masking facility-wide; and the use of recommended PPE (ie, isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20013756_as4\"><jats:title>Results:<\/jats:title><jats:p>Of 725 staff and residents tested through targeted testing and serial PPSs, 21 (3%) were SARS-CoV-2 positive: 16 (76%) staff and 5 (24%) residents. Fifteen cases (71%) were linked to a single unit. Targeted testing identified 17 cases (81%), and PPSs identified 4 cases (19%). Most cases (71%) were identified before IPC interventions could be implemented. WGS was performed on SARS-CoV-2 isolates from 4 staff and 4 residents: 5 were of Santa Clara County lineage and the 3 others were distinct lineages.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20013756_as5\"><jats:title>Conclusions:<\/jats:title><jats:p>Early implementation of targeted testing, serial PPSs, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.1375","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T10:31:59Z","timestamp":1607941919000},"page":"1173-1180","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":16,"title":["Timely intervention and control of a novel coronavirus (COVID-19) outbreak at a large skilled nursing facility\u2014San Francisco, California, 2020"],"prefix":"10.1017","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6657-0052","authenticated-orcid":false,"given":"Ellora N.","family":"Karmarkar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irin","family":"Blanco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauli N.","family":"Amornkul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amie","family":"DuBois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianding","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick K.","family":"Moonan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth L.","family":"Rubenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David 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P.","family":"Dauterman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Ongpin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilmie","family":"Hathaway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Trammell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejovwoke F.","family":"Dosunmu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guixia","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenith","family":"Khwaja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawzaneen Z.","family":"Talai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice K.","family":"Louie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan 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A.","family":"Wadford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveena","family":"Bobba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Stoltey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Epson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Y.","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayanna S.","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber M.","family":"Vasquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,12,14]]},"reference":[{"key":"S0899823X20013756_ref10","unstructured":"10. Testing guidelines for nursing homes. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/nursing-homes-testing.html. Published 2020. 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COVID Data Tracker. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/cases-updates\/cases-in-us.html. Published 2020. Accessed December 10, 2020."},{"key":"S0899823X20013756_ref19","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-019-0637-9"},{"key":"S0899823X20013756_ref21","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6921e1"},{"key":"S0899823X20013756_ref5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008457"},{"key":"S0899823X20013756_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/nprot.2017.066"},{"key":"S0899823X20013756_ref11","unstructured":"11. Interim guidance on testing healthcare personnel for SARS-CoV-2. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/testing-healthcare-personnel.html. Published 2020. Accessed December 10, 2020."},{"key":"S0899823X20013756_ref13","unstructured":"13. Symptoms of coronavirus. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/symptoms-testing\/symptoms.html. Published 2020. Accessed December 10, 2020."},{"key":"S0899823X20013756_ref9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6913e1"},{"key":"S0899823X20013756_ref4","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6912e1"},{"key":"S0899823X20013756_ref24","doi-asserted-by":"publisher","DOI":"10.1126\/science.abb9263"},{"key":"S0899823X20013756_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkf436"},{"key":"S0899823X20013756_ref2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1017\/ice.2018.308","article-title":"Infection prevention in long-term care: re-evaluating the system using a human factors engineering approach","volume":"40","author":"Katz","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X20013756_ref20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001191"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20013756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:39:31Z","timestamp":1633999171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20013756\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,14]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["S0899823X20013756"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.1375","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,14]]},"assertion":[{"value":"\u00a9 The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution license (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}