SHEA: Do Not Screen Symptom-Free Patients for COVID-19 Upon Hospital Admission

This week the Society for Healthcare Epidemiology of America (SHEA) made the recommendation for healthcare facilities to not test for COVID-19 in new patients who are symptom-free during their hospital admission process or prior to procedures.

This recommendation was published on Wednesday in Infection Control & Hospital Epidemiology.

“Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls,” the authors wrote.

Testing continues to be challenging and with the evolving virus mutations, such new guidance may alleviate unnecessary tests and create time efficiencies for hospital personnel. The authors also cited research that shows asymptomatic COVID testing added 1.89 hours to the length of stay in the emergency department of an academic health system, and another study from a specialty hospital showed it cost more than $12,500 to identify one asymptomatic COVID patient.

“The small benefits that could come from asymptomatic testing at this stage in the pandemic are overridden by potential harms from delays in procedures, delays in patient transfers, and strains on laboratory capacity and personnel,” said Thomas R. Talbot, MD, MPH, the Chief Hospital Epidemiologist at Vanderbilt University Medical Center, and a member of the SHEA Board of Directors. “Since some tests can detect residual virus for a long period, patients who test positive may not be contagious.”

The authors did acknowledge the need for clear guidelines. “Calls for more detailed guidance on when and how to utilize asymptomatic screening as an infection prevention intervention have increased,” they wrote. “Unfortunately, although we are now nearing the end of the third year of the COVID-19 pandemic, the challenge in crafting any sort of standardized guideline continues to center on very limited data assessing the true impact, both positive and negative, of this strategy.”

SHEA said that facility risk assessments that include targeted scenarios, patient populations, or locations that may require added interventions along with community COVID-19 metrics should drive whether asymptomatic screening is part of institutional practices. While it is imperative to prevent healthcare-associated spread of respiratory pathogens, it is critical to examine which methods, when added upon core layers of infection prevention, work best to protect patients and healthcare providers.

In addition, they recommend a hierarchy of controls to prevent infections can include universal use of N95 respirators when performing certain procedures, active screening of healthcare providers for signs of COVID-19, unit layouts that reduce shared patient spaces, and enhanced cleaning and ventilation.