Guidelines for Hospitalized Patient Re-Testing & *Clinical Risk Factors · Fever >100.0

Removal of Isolation Precautions in COVID-19 PUIs · New hypoxia requiring O2 Effective starting May 21st, 2020 · Cough · Direct exposure to known positive person

Person Under investigation: COVID PCR Test Pending - COVID isolation precautions per policy - Obtain additional COVID lab work up - Continue investigating and treating for alternative cause of presenting symptoms

- Continue COVID isolation precautions per policy - Discontinue isolation precautions per table page 2 Initial COVID PCR - Do not re-test inpatient unless at least 21 days test results POS have elapsed from first test - Treatment based on current evidence including clinical trials NEG

Does the pt. Is the chest x-ray have known CHF consistent with YES or interstitial NO High Risk COVID lung disease?

NO YES Note: >6 L O2 or Repeat Intubated or testing will How many clinical CPAP or impact Low Risk 0 to 1 risk factors* are BiPAP? present? YES enrollment in clinical trials 2 or more

YES/ Alternative Intermediate INDETERMINATE diagnosis likely? NO Risk Keep on COVID isolation precautions per policy Repeat COVID PCR Testing YES Obtain non- NO Nasal pharyngeal swab or bronchial aspirate if intubated contrast CT of No further chest COVID testing indicated

Imaging concerning for NEG Test result? POS COVID?

NO

Follow policy for discontinuation Continue to treat patient as if Continue COVID isolation precautions per policy and of isolation precautions COVID positive and continue treatment based on current Continue clinical management isolation precautions evidence including clinical trials

Changes since last version: · Added guidance to “initial positive” test result end point · Added “no re-testing necessary” verbiage to table (pg 2)

© North Memorial Health 2020 V8 5/21/20 Discontinuation of Precautions for Positive/Highly-Suspect Cases MDH, Interim Guidance for Hospital Discharge to Home or Admission to Congregate Living Settings and Discontinuing Transmission-Base Precautions, published 4/8/20. CDC, Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance). 4/30/20 https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html

Changes since last version: · Added “no re-testing necessary” verbiage to table (pg 2)

© North Memorial Health 2020 V8 5/21/20