Objectives: Identify facility factors associated with a larger COVID-19 outbreak among residents in Maryland nursing homes (NHs). Design: Observational Setting and Participants: All Maryland NHs. Methods: Resident COVID-19 cases were collected for each Maryland NH from January 1, 2020 through July 1, 2020. Cumulative COVID-19 incidence through July 1, 2020 was collected for each county and Baltimore City. Facility characteristics for each Maryland NH were collected from time periods prior to January 1, 2020. NH outbreaks were defined as larger when total resident COVID-19 cases exceeded 10% of licensed beds. Descriptive and multivariable analyses were conducted to assess the strongest predictors for the primary outcome of larger COVID-19 outbreak. Results: NHs located in counties with high cumulative incidence of COVID-19 were more likely to have larger outbreaks (OR 4.5, 95% CI 2.3-8.7, p<0.01). NHs with at least 100 beds were more likely to have larger outbreaks, especially among facilities with >140 licensed beds (100-140 beds vs <100 beds: OR 1.9, 95% CI 0.9-4.1, p=0.09; >140 beds vs <100 beds: OR 2.9, 95% CI 1.3-6.1, p<0.01). NHs with more short-stay residents (OR 2.2, 95% CI 1.1-4.8, p=0.04) or fewer Certified Nursing Assistant hours daily (OR 2.6, 95% CI 1.3-5.3, p<0.01) also were more likely to have larger outbreaks. Resident race and gender were not significant predictors of larger outbreaks after adjustment for other factors. Conclusions: Large NHs with lower staffing levels and many short-stay residents in counties with high COVID-19 incidence were at increased risk for COVID-19 outbreaks. Understanding the characteristics of nursing homes associated with larger outbreaks can help us prepare for the next pandemic.

中文翻译：

---

与马里兰养老院中较大的COVID-19暴发相关的短期住院和人员减少

目标：确定与马里兰疗养院（NHs）居民中较大的COVID-19爆发有关的设施因素。设计：观察性环境和参加者：所有马里兰州NH。方法：从2020年1月1日至2020年7月1日，为每个马里兰州NH收集居民COVID-19病例。至2020年7月1日，为每个县和巴尔的摩市收集累积的COVID-19发病率。从2020年1月1日之前收集每个马里兰州NH的设施特征。当常驻COVID-19病例总数超过许可床位的10％时，NH的暴发被定义为更大。进行了描述性和多变量分析，以评估更大的COVID-19爆发主要结果的最强预测因子。结果：累积COVID-19发生率较高的县中的NHs爆发可能性更大（OR 4.5，95％CI 2.3-8.7，p <0.01）。至少拥有100张病床的NHs更容易爆发，尤其是在拥有超过140张病床的设施中（100-140张病床vs <100张病床：OR 1.9，95％CI 0.9-4.1，p = 0.09；> 140张病床vs <100张床：或2.9，95％CI 1.3-6.1，p <0.01）。短期居留人数较多的OR（OR 2.2，95％CI 1.1-4.8，p = 0.04）或每天较少的合格护理助理小时数（OR 2.6，95％CI 1.3-5.3，p <0.01）的NHs也更有可能较大的爆发。调整其他因素后，居民种族和性别不是更大暴发的重要预测指标。结论：在COVID-19发病率较高的县，大型NHs的人员配备水平较低，且许多短期住宿的居民发生COVID-19的风险较高。了解与较大爆发相关的疗养院的特征可以帮助我们为下一次大流行做好准备。