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Report of an Outbreak: Nursing Home Architecture and Influenza‐A Attack Rates
Author(s) -
Drinka Paul J.,
Krause Peggy,
Schilling Margo,
Miller Barbara A.,
Shult Peter,
Gravenstein Stefan
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb01859.x
Subject(s) - medicine , outbreak , nursing homes , attack rate , retrospective cohort study , census , emergency medicine , environmental health , nursing , virology , population
OBJECTIVE: To determine factors that might account for a significantly lower attack rate in a newly constructed nursing building during an epidemic of type A influenza. SETTING: A four‐building, long‐term care facility for veterans and their spouses, with an average daily census of 690. DESIGN: Prospective surveillance with retrospective analysis. PARTICIPANTS: Symptomatic residents submitting to viral culture. MEASUREMENTS: Number of respiratory illnesses and influenza cultures in consenting symptomatic residents. Building characteristics RESULTS: An influenza A (H3N2) outbreak was culture‐confirmed in 68 nursing home residents. Influenza A was isolated in 3/184 (2%) residents in Building A, 31/196 (16%) in Building B, 18/194 (9%) in Building C, and 16/116 (14%) in Building D. Denominators are average daily census during the outbreak. Building A had significantly fewer culture‐confirmed cases than the other buildings ( P < .001). Fewer residents in Building A, 47% compared with 61% in Buildings B, C, and D, were participants in a formal study of influenza. Eight of 15 respiratory illnesses identified during the outbreak that were not cultured occurred in Building A. These factors could not account for the difference in attack rates. Building A has a unique ventilation system, more square feet of public space per resident, and does not contain office space that serves the entire four‐building facility. CONCLUSION: Our retrospective observation suggests that architectural design may influence the attack rate of influenza A in nursing homes. J Am Geriatr Soc 44:910–913,1996.