Highlight
1. On-site point-of-care respiratory multiplex PCR testing in nursing homes (NHs) increased viral testing rates and improved case detection of SARS-CoV-2, influenza, and RSV during seasonal outbreaks.
2. Despite no reduction in outbreak number or size, this testing strategy significantly decreased resident emergency department (ED) transfers related to respiratory infections.
3. The use of POC-RMPCR enabled earlier initiation of antiviral therapy, shortening time from symptom onset to treatment by approximately 2.5 days.
4. Seasonal adoption of point-of-care multiplex PCR testing could prevent an estimated four ED transfers per 100 beds in long-term care facilities.
Study Background
Respiratory infections caused by SARS-CoV-2, influenza viruses, and respiratory syncytial virus (RSV) are major contributors to morbidity and mortality in nursing home (NH) populations globally. Crowded living conditions and the frailty of elderly NH residents often result in rapid transmission and severe outcomes. Traditional approaches to outbreak management rely on centralized laboratory testing with delayed results, influencing the timing of infection control measures and antiviral interventions. Point-of-care respiratory multiplex polymerase chain reaction (POC-RMPCR) testing offers rapid, on-site pathogen identification, potentially facilitating timely clinical and public health responses. However, the real-world effectiveness of POC-RMPCR testing in reducing outbreak size and improving clinical outcomes in NH settings required rigorous evaluation.
Study Design
This multicenter, open-label cluster randomized clinical trial was conducted in 20 nursing homes in Toronto, Ontario, Canada, from November 12, 2024, through May 2, 2025. These facilities had an aggregate capacity of 3,963 beds, with a median of 5.5 units per home and an average of 30 beds per unit. The crowding index, a measure of residential density, was 1.42, reflecting close quarters among residents. NHs were randomized to either the intervention arm—where trained NH staff performed on-site POC-RMPCR testing for respiratory viral pathogens—or to standard care without onsite multiplex testing. The primary outcome was a composite measure encompassing the number and size of respiratory outbreaks caused by SARS-CoV-2, influenza, and RSV. Secondary outcomes included the rates of emergency department (ED) transfers and mortality among residents during outbreak periods. Data analysis was completed between October and December 2025.
Key Findings
The intervention group and control group reported similar total numbers and sizes of outbreaks (51 vs. 62 outbreaks, respectively), with a rate ratio of 1.12 (95% CI, 0.78 to 1.58), indicating no statistically significant difference in outbreak occurrence or magnitude attributable to on-site test availability. However, the intervention homes demonstrated significantly higher viral testing rates, conducting 3.69 tests per week compared to 1.73 tests in control NHs. The ratio of confirmed cases to suspected cases was more than doubled in the intervention group (4.2 versus 2.0), suggesting enhanced diagnostic accuracy and case ascertainment with POC-RMPCR.
Importantly, residents in NHs with on-site testing experienced fewer ED transfers. Confirmed infection–related ED transfers decreased by 3.5% (95% CI, -7.2% to -0.2%), and combined confirmed plus suspected infection-related transfers dropped by 11.0% (95% CI, -20.6% to -2.0%). Mortality rates remained similar between groups, indicating no detectable effect on death outcomes. Earlier antiviral therapy was initiated in intervention homes, with a median reduction in time from symptom onset to treatment of 2.5 days (95% CI, -3.1 to -1.9 days), likely reflecting the benefit of rapid pathogen identification through POC testing. The authors estimate that seasonal routine deployment of on-site multiplex PCR testing in NHs could prevent approximately four ED transfers per 100 beds, thereby reducing healthcare utilization and potentially mitigating risks associated with hospital transport of vulnerable elderly residents.
Expert Commentary
This study provides robust, randomized clinical evidence supporting the strategic implementation of point-of-care respiratory multiplex PCR testing in long-term care settings. While the intervention did not reduce outbreak size or frequency, the improved case detection and faster initiation of antivirals demonstrate meaningful clinical impact by lowering the need for emergency transfers. Avoiding unnecessary ED visits is particularly relevant in the context of infectious disease pandemics and seasonal surges, where hospital capacities are stressed and vulnerable populations face risks of hospital-acquired complications.
The lack of reduction in outbreak size may reflect the high transmissibility of these viruses and the ongoing challenge of infection prevention in crowded NH units. Nonetheless, rapid diagnostics empower better clinical decision-making and targeted antiviral use. The trial’s open-label cluster design adds strength to the generalizability of findings across diverse NH environments.
Limitations noted include the study’s conduct in a single metropolitan area, which may limit extrapolation to regions with differing NH structures or viral epidemiology. Furthermore, mortality was not reduced, suggesting that while early treatment and diagnostic clarity are beneficial, these alone do not modify fatal outcomes among frail residents. Future research might explore integration of POC testing with enhanced infection control measures or novel antiviral strategies.
Conclusion
In summary, point-of-care respiratory multiplex PCR testing in nursing homes substantially amplifies viral testing frequency and diagnostic yield, expedites antiviral therapy, and reduces emergency department transfers during respiratory virus outbreaks. Although it does not diminish outbreak frequency or size, its utility in improving care pathways and minimizing hospital utilization in this high-risk population is evident. Adoption of POC-RMPCR testing should be considered a valuable component of respiratory outbreak management programs in long-term care facilities to enhance resident outcomes and healthcare efficiency.
Funding and Trial Registration
The trial was registered at ClinicalTrials.gov with identifier NCT06660433. Funding sources were not specified in the abstract but are detailed in the full publication.
References
1. Kandel C, Oriotis D, Candon HL, et al. Respiratory Outbreak Mitigation With Point-of-Care Testing in Long-Term Care: A Randomized Clinical Trial. JAMA Intern Med. 2026;published online July 6. PMID: 42406366.
2. Centers for Disease Control and Prevention. Influenza and respiratory viruses in long-term care. CDC guidelines. Available at: https://www.cdc.gov/longtermcareresources/influenza
3. Smith C, et al. Multiplex PCR for rapid diagnosis of respiratory viruses in elderly populations: Clinical impact and utility. Clin Infect Dis. 2024;78(1):35-42.
