Nursing homes and long-term care (LTC) facilities have experienced some of the most deadly outbreaks of COVID-19, often with a devastatingly high mortality rate. Life Care Center of Kirkland in Washington State was one of the nursing homes hit first and hardest by COVID-19, with two-thirds of the residents infected and 35 deaths. In response to the significant trend of COVID-19 infections among nursing home residents and staff, governments around the world have launched inquiries and investigations. The Scottish Health Secretary is calling for a review of the entire nursing home system, and a commission in England is investigating potential human rights breaches in nursing homes. Nursing homes in many places in the United States are seeking immunity from lawsuits filed by families of residents who died of COVID-19. It is clear that in the future the infection prevention and control practices of nursing homes will be under intense scrutiny, both by governments and the public.
The infection prevention and control practices in nursing homes have been suspect for some time. It has been well known that residents at nursing homes are at high risk for contracting infectious diseases, such as seasonal influenza and norovirus, however the recent COVID-19 outbreak has highlighted the need for improved prevention measures, earlier infection detection and coordinated management. These measures are ethically necessary not just for the well-being of residents, but also to restore public trust in nursing homes.
Considering all these factors, and the failure of the current system, it is clear that going forward cannot be business as usual. Nursing home administrators must employ novel approaches. Artificial Intelligence (AI) offers one such solution to the threat that infectious diseases pose to nursing homes and their residents.
AI entails the simulation of human intelligence by machines, computer systems in particular. Applied to nursing homes, AI systems can collect and assess data to minimize the risk of infection in ways far superior to conventional systems of infection control. Simple yet effective AI systems should focus on three key goals: to predict the risk of infection among visitors and staff, ensure staff compliance with hygiene and Personal Protective Equipment (PPE) between resident contacts, and facilitate early detection of infection among residents.
Nursing home staff can introduce infections into nursing homes, where they spread among residents. There are two ways that this can happen. One way is introducing infections from outside into the nursing home, and the other is transmitting infections between nursing home residents. Fortunately, AI can assist in both instances.
Staff can transmit infections from outside nursing homes if they have encountered someone in their family or in the community who is infected. In addition, many nursing home employees work at multiple nursing home sites, increasing the risk of transmitting from one facility to another. Another factor that plays a role is that staff often lack paid sick leave, causing them to report for work even when they are potentially infectious. As well, as is the case with COVID-19, transmission of some diseases can occur from an infected person before that person shows symptoms.
While improved wages and a more robust sick leave policy could help reduce staff transmission of infections, AI provides reliable, automated, and highly predictive screening of staff for possible infection with COVID-19. Because AI is objective, it doesn’t depend on human judgment to determine whether someone can work their shift. Utilizing AI to screen staff for possible infection with COVID-19 would significantly reduce the risk of introducing COVID-19 and other infections into nursing homes. Applying the same technology to visitors, families, volunteers, and clergy could also reduce the risk of infections being brought into nursing homes from the community.
A lack of good hand hygiene and failure to wear adequate PPE allows staff to spread infections between residents in LTC facilities. Many nursing home residents require frequent contact with staff for meals, bathing, and basic activities of daily living. Failure to comply with hand hygiene and PPE policies between resident contacts is a significant means by which infections can be transmitted between residents. AI offers systems to foster compliance with both hand hygiene and the wearing of PPE. By reminding staff to adhere to high standards of infection prevention through hand hygiene and proper use of PPE, these systems would significantly reduce the risk of transmitting infections between nursing home residents. Moreover, the risk of nursing home staff being infected themselves, and spreading infections to their families and communities would also be reduced.
An essential component of any infection control program is the early identification of infected individuals so as to initiate treatment, and also isolate or cohort so as to reduce the risk of further transmission. Delays in identifying, isolating, and medically managing potentially infectious residents can lead to the spread of infection, even before the person is manifesting symptoms. In many instances, detection relies on residents reporting symptoms. However, many nursing home residents experience cognitive impairment or dementia and are unable to notice and report subjective symptoms. The particular vulnerability of residents was highlighted by the number of COVID-19 associated deaths at a dementia facility for retired Roman Catholic nuns. By monitoring vital signs and biomarkers, AI algorithms have been shown to diagnose infections up to 48 hours before observable symptoms. When applied to nursing home residents, particularly in the context of an infectious agent that can be transmitted well before symptoms are observed, early detection of infections through AI would significantly reduce the risk of infections spreading unabated through nursing homes. As well, AI systems would remove subjective and uneven assessments by nursing home staff, addressing the current delay in recognizing infections and isolating residents.
Nursing homes cannot return to their inadequate systems to protect residents and staff from infectious diseases. Relying on human factors alone to prevent, detect, and manage infections in nursing homes facilities has failed. Nursing homes and LTC facilities must therefore turn to novel approaches that are objective, adaptable, and reliable. Nursing homes must take the hard lessons of this pandemic to heart and leverage AI technology. This is the best way to fulfill their ethical obligation to protect their residents and restore public trust.