How a long-term care home in Montreal managed to ward off COVID-19


MONTREAL – The Pavillon Camille-Lefebvre long-term care home in southwest Montreal is home to some of the most vulnerable patients to a pandemic, including 18 who are living on ventilators full time. But as COVID-19 swept across Montreal’s nursing homes as a seemingly unstoppable force, the Pavillon Camille-Lefebvre achieved a rare feat: not a single positive case, let alone deaths from COVID-19.

Montreal is Canada’s COVID-19 hotspot, with more than 28,772 cases and 3,437 deaths on Friday. About 80% of deaths in the province have occurred in retirement homes and long-term care homes.

Information obtained from Montreal’s five health boards suggests that only a handful of establishments have been able to avoid infection. In addition to the Pavillon Camille-Lefebvre, these include two private establishments in the Nordic region, a small establishment located in a hospital and a larger public nursing home.

A few others, including the Montreal Chinese Hospital, were able to prevent the spread of the virus despite one or two cases.

Judith Morlese, nurse manager at Pavillon Camille-Lefebvre, believes that the establishment’s success in preventing COVID-19 is more than luck.

She says rapid action, dedicated infection control teams and constant communication with staff were some of the keys to keeping the virus at bay, and that they could provide a plan for other homes to follow. in the event of a second wave.

Morlese said it was essential to act early, often before provincial government directives, to prevent infection.

The center began developing a pandemic plan in January, before the first case in the province was declared, and made the decision early on to ban visitors and demand that staff members returning from the stranger stay home until tests show they were not infected.

In February, meetings to discuss the pandemic were held daily.

Staff were picked up early and went through a careful screening process each day before work. They were told to stay home and get tested when symptoms first appeared.

As cases began to crop up elsewhere, anxiety increased. Employees were met at the start of each shift and reminded to treat all patients, and each other, as if they were positive.

“We were nervous because we saw what was going on, and we felt bad for our network partners, we were scared,” Morlese said in an interview. “So that’s the truth. We were really, really scared. ”

Morlese says a big part of the home’s success has come from diligently following simple sanitary guidelines about disinfecting equipment, washing hands, and wearing protective gear.

However, the facility also had two advantages that many others did not have: namely, a skilled infection control team and the ability to prevent staff from working in multiple facilities.

The 135-bed facility is also linked to the Lachine hospital and is part of the McGill University Health Center, which proved to be an advantage as it meant better access to epidemiologists and other experts, according to Morlese.

France Nadon, a home infection control consultant, said part-time workers with multiple jobs were asked not to work elsewhere if they wanted to continue working at the Pavilion.

Those who stayed were offered full-time work, which helped the home avoid the staffing shortage that authorities cited as a weak spot that allowed COVID-19 to enter so many homes.

Infection control specialists were on hand to answer questions from employees and give refresher courses on the proper use of protective gear, Nadon said.

Between 10 and 15 employees acquired COVID-19 outside of work, but none of them passed it on to patients – which Nadon says is a tribute to the vigilance they have shown in hand washing, disinfection and physical distancing.

“They followed the rules, they kept their masks on, they washed their hands and the visor,” she said.

Henry Siu, an associate professor at McMaster University who has studied long-term care readiness, says researchers are still studying the factors that result in a successful fight against the virus.

While much is unknown, he says homes that pioneered measures such as stricter visitation policies and limiting workers to a single establishment may have performed better.

In Ontario, he said, private homes appear to have been less successful, perhaps because of aging buildings designed to house multiple residents in one room and insufficient space to distance themselves.

He said that while “luck is likely to have a role to play” in homes with major outbreaks, those who are proactive, have up-to-date infection control protocols and strong leadership “will be much better equipped to do so. to face. epidemics. ”

As health officials warn of a possible second wave, Siu said he hoped Canadian long-term care homes would be better prepared.

But while they may have become more vigilant about distance, hygiene and symptom monitoring, he said systemic issues, including poor house design, low wages, and poor working conditions which force workers to hold multiple jobs are more difficult to resolve.

Nadon and Morlese say they are yet to celebrate the success of their house.

Although they are tired, they remain focused on the possibility of a second wave, which could come just when they also have to grapple with an attack of the flu and other seasonal respiratory viruses.

Morlese says that while the worry is not gone, they feel more prepared this time.

“We are less stressed because we know what we have to face,” she said.

This report by The Canadian Press was first published on August 2, 2020


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