The use of continuous temperature monitoring in staff and older residents of independent- and assisted-living facilities may be an effective intervention for early detection and containment of infectious disease outbreaks, and provide better outcomes for people in those facilities, according to a study conducted by scientists at Wake Forest University School of Medicine.
The study findings are published in the current online edition of the Journal of the American Medical Directors Association.
“As we saw during the early days of the COVID pandemic, nursing homes and other congregate living facilities were often hotspots of infection due to the residents’ advanced age, chronic medical conditions and frailty, as well as inherent infection risks associated with congregate living,” said the study’s lead author, Dr. Eric Kirkendall, deputy director of the Center for Healthcare Innovation at Wake Forest University School of Medicine.
“Also, fever in older adults can be more difficult to detect due to increased variations in their baseline temperatures than in younger people, so our team thought that continuous monitoring might be a way to detect individual or widespread outbreaks earlier.”
To test the hypothesis, the research team conducted a feasibility study on the use of a self-applied continuous temperature monitoring patch, developed by Verily, in a local congregate-living facility as compared to traditional intermittent assessments with a thermometer. Facility staff also were included in the study to better understand how infection might spread.
Thirty-five participants, including 25 residents and 10 staff, were enrolled in the 90-day trial from March to July 2021. Participants wore a continuous temperature sensor that measured body temperature every 30 seconds while transferring data to the cloud and a smartphone application in real time. For this study, fever was defined as temperature of or greater than 100.4 degrees Fahrenheit.
The initial application of the patch for each participant was completed by a study coordinator to demonstrate appropriate application technique. All participants were instructed to apply a new patch in the same manner every 3 to 7 days. Independent-living residents were also asked to record their oral temperatures in the morning and evening with provided thermometers for comparison. Facility protocol required staff to have their temperature taken at the door of the facility before their shifts, for which they were asked to self-record their temperatures in a log.
Primary outcomes included study completion, ability to re-apply the sensor, temperature data acquisition and data availability from the sensors. A secondary analysis of the temperature data involved comparing the method of obtaining temperature using the continuous-monitoring device against standard of care using traditional manual thermometers.
The researchers found that a wearable device that continuously monitored temperature in an older adult population and the staff in congregate living facilities was feasible and acceptable. This approach identified fever undetected by current standard of care indicating the potential capability of this device for earlier detection of fevers.
Overall, 91% of residents who were in the study were able to apply the device without assistance, and 80% of resident participants completed the study. For staff participants, completion and re-application rates were 100%.
“Given that fevers were detected by the patch during this study, even with a short duration and small sample size, we believe there is much importance to future clinical operations and procedures, although additional, larger studies are needed to confirm,” Kirkendall said.
A significant and unexpected finding was the device identified fevers in four participants that usual care did not. This is a key finding that demonstrates the value of continuous monitoring, especially in this high-risk population, Kirkendall said.
Funding for the study was provided by Verily, a subsidiary of Alphabet that focuses on life sciences and healthcare.