Infection Control

A move away from large facilities

The role of the built environment in relation to COVID-19 infection spread and control was identified within the Expert Panel of Nursing Homes’ report. It was noted that several stakeholders argued for a move away from large facilities to households with lower numbers of residents. These stakeholders pointed to progress in other services, such as specialist services for people with intellectual disabilities and people with enduring mental health issues, where people have been moved out of congregated settings and into community integrated settings.


“Smaller household models of residential care permit changes in infrastructure from the traditional institutional model to an environment that more resembles a family home (accommodating – 12 people). Construction of facilities like this are national policy and this model has become the norm in some European countries for 10 or many years”.

- The Panel


According to the USE Centre for Disease Control (CDC, 2020), respiratory viruses are mainly transmitted through contact, droplets, and airborne routes. Infection control strategies must take account of all transmission routes, however, there is growing evidence that contact transmission of COVID-19 is generally lower risk (CDC, 2021) and that the principal modes of transmission involve respiratory droplets and airborne transmission.

Additionally, infection control measures resulted in secondary impacts, i.e., restricted visitor access, resident quarantine, constrained social interaction, and the limitation of shared activities. These impacts negatively affect mental health and well-being, with those in RLTC more likely to report missing family as a source of stress (McCarron et al., 2021).

“her environment went from a homely place, with smiling staff to everyone wearing masks, keeping distance... It made her home very clinical, more like a hospital setting. Even now, when we can visit inside again, it is odd and distancing for us to be wearing masks. Health wise it is a necessary tool to reduce spread of germs, but still has an impact on her. Also, when we had window visits masks made it difficult for her to hear us, read lips/facial expressions etc.
On a personal level, I feel the whole COVID-19 lockdown and restrictions have had a negative effect on our mother. She has greatly missed the contact with visitors. I notice this by way of her conversation now. Also getting confused more easily. The whole experience has made her feel more like an inmate than a resident”.

- Family Member