Outbreak Response in Aging Services

​​During an outbreak in an aging services organization, cohorting—when done correctly and in conjunction with other infection prevention and outbreak response practices—can greatly enhance the organization's ability to prevent and control the spread of infection, along with concurrent gains in maintaining operations while minimizing risk to residents and staff. However, one size does not fit all providers. Although effective cohorting practices for a given infectious disease are generally consistent from one aging services organization to the next, the practical implementation can differ depending on the provider's building layout and design, among other factors.

Building design and layout can help to inhibit or promote incidents and adverse events. Poor design of cohort units can undermine infection prevention and control efforts during an outbreak. The adage "form follows function" conveys the idea that we should design things to support the functionality we want to achieve. When we fail to do so, the opposite often happens—design determines function, often with suboptimal results.

When design works against other elements that make up a care and service environment, it can increase the likelihood of risks, hazards, and adverse events, and even lead to great harm or loss of life. For example, poor design and layout can diminish the effectiveness of other care-critical elements such as staffing and scheduling, workloads, the ability to complete work assignments, medical oversight, care routines, and resident routines (see Figure 1. Elements of the Care and Service Environment). In the case of an outbreak response, poor design can also negatively affect efforts like hand hygiene, identification of changes in condition, the proper use of personal protective equipment (PPE), pathogen testing strategies, and enhanced terminal and daily cleaning and disinfection, thus increasing the risk of infection transmission. These realities are evident during the COVID-19 pandemic and apply to any outbreak.

Conversely, a systems approach aligns design and layout with other elements of the care and service environment, strengthening the entire environment and increasing its adaptability and resilience. (See What Is Systems Thinking? for more information.) Under a systems approach, cohorting does not merely stall transmission of infections. It also has other positive effects, such as maximizing facility operating potential during challenging times...