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Point Prevalence Survey Testing in Acute Care Facilities (PDF) MINNESOTA DEPARTMENT OF HEALTH Considerations for SARS-CoV-2 Testing in Acute Care Facilities 9 / 2 3 / 2021 The Delta variant of SARS-CoV-2, the virus that causes COVID-19, has become the dominant strain circulating in the U.S. This virus variant spreads more easily and quickly than the early SARS-CoV-2 virus, leading to more cases of COVID-19, especially among unvaccinated and otherwise vulnerable people. SARS-CoV-2 often enters health care facilities through infected health care workers (HCW). The objective of proactive testing is to identify infectious people before they can spread the virus to others. The following points underscore why this testing can be important to identify unrecognized infections. Throughout the pandemic, mild symptoms consistent with COVID-19, especially those that overlap with symptoms of seasonal allergies, have challenged health care workers and the infection prevention and occupational health teams tasked with pre-shift screening. MDH knows of situations where SARS-CoV-2 has circulated among health care workers, despite the use of symptom screening and testing protocols for symptomatic health care workers. MDH data shows that health care workers are more likely to test positive after nonwork SARS-CoV-2 exposures. Reduced preventive measures in the community and increased transmissibility of the Delta variant have made it increasingly difficult to identify all nonoccupational exposures, making post-exposure testing less impactful as a sole means of identifying asymptomatic and presymptomatic health care workers. Fully vaccinated health care workers are most likely to test positive in the 14 days after a household or social exposure (versus after a high-risk occupational exposure). While CDC does not recommend quarantine of fully vaccinated health care workers after high-risk exposure, SARS-CoV-2 testing of these health care workers after recent or ongoing household exposure may reduce risk of virus entry into health care settings. Local (e.g., county) SARS-CoV-2 infection rates influence the number of potential introductions of the virus into health care facilities. It is essential to consider patients and health care workers, as well as transmission dynamics in the surrounding community, when implementing measures to detect and prevent SARS-CoV-2 transmission. 1 of 6 CONSIDERATIONS FOR SARS- COV- 2 TESTING IN ACUTE CARE FACILITIES Testing opportunities The table below includes situations in which proactive SARS-CoV-2 testing could be considered in acute care facilities. Situation Testing Who to Include Who to Exclude Symptoms. Test person for SARS-CoV-2 immediately. Unvaccinated . None . Vaccinated Symptomatic patient, client, or HCW, regardless of vaccination status or prior infection history. Confirmed SARS- CoV-2 infection in last 90 days Exposure. Test for SARS-CoV-2 immediately (but not earlier than . Unvaccinated . Confirmed SARS- two days after the exposure) and, if negative, five to CoV-2 infection in . Vaccinated Regardless of vaccination status: seven days after exposure.# last 90 days . HCW with a high-risk exposure inside or outside of work. HCW with exposure to a large gathering or event where social distancing was not possible. Patients with prolonged close contact to a person with COVID-19. Transmission within a facility.* Consider repeated point prevalence surveys (PPS) of . Unvaccinated . Confirmed SARS- HCW and patients in the affected unit, ward, floor, CoV-2 infection in . Vaccinated Outbreak of SARS-CoV-2 in a unit, ward, or floor. regardless of vaccination status. last 90 days OR Test all HCW and patients every three to seven days until 14 days pass since last test-positive person Evidence of nosocomial transmission involving patients detected. and/or HCW. Additional PPS details are below. 2 of 6 CONSIDERATIONS FOR SARS- COV- 2 TESTING IN ACUTE CARE FACILITIES Situation Testing Who to Include Who to Exclude Susceptible population. Consider implementing routine testing of unvaccinated . Unvaccinated . Vaccinated HCW (e.g., weekly, twice weekly). Confirmed SARS- Low county vaccination rate (e.g., less than 70% of CoV-2 infection in total population).1 last 90 days Susceptible population. In addition to testing patients at admission, consider . Unvaccinated . Confirmed SARS- testing on day three to five after admission. CoV-2 infection in . Vaccinated Low facility HCW vaccination rate (e.g., less than 70%). last 90 days Community transmission.2 Moderate or substantial transmission: Consider . Unvaccinated . Confirmed SARS- implementing weekly routine testing of unvaccinated CoV-2 infection in . Vaccinated Moderate, substantial, or high community HCW. last 90 days transmission. High transmission: Consider implementing twice weekly routine testing of unvaccinated HCW. Consider including vaccinated HCW in routine testing. Incoming patients. At discretion of facility. Unvaccinated . Confirmed SARS- CoV-2 infection in . Vaccinated Pre-procedure or pre-admission testing. last 90 days #CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic (www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html) *Report outbreaks or evidence of nosocomial transmission to MDH at [email protected]. 1 Vaccine Data (https://mn.gov/covid19/vaccine/data/index.jsp) 2 CDC COVID Data Tracker: COVID-19 Integrated County View (https://covid.cdc.gov/covid-data-tracker/#county-view) 3 of 6 CONSIDERATIONS FOR SARS- COV- 2 TESTING IN ACUTE CARE FACILITIES Point prevalence survey testing Testing a group of people at a single point in time is called a “point prevalence survey,” or PPS. This type of testing provides information on the overall number of people (patients and staff) affected in an entire health care facility, or in a specific department or unit. Conducting one or more rounds of testing when undetected transmission is suspected helps health care leaders identify infected patients and staff before they get symptoms or if they never get symptoms. This makes it possible to manage people who are infected to limit further spread of SARS-CoV-2 within the unit and facility. PPS is most successful when all eligible people participate until testing rounds are complete. Hospital administrators, medical leadership, and legal teams should establish protocols that address health care workers participation. COVID-19 Recommendations for Health Care Workers (www.health.state.mn.us/diseases/coronavirus/hcp/hcwrecs.pdf) How is PPS testing done? All eligible members of a group of people should be tested for SARS-CoV-2 at the same point in time (i.e., on the same day or within a day or two of each other). Staff who test positive should be removed from the workplace. Patients who test positive should be isolated. Contacts of test-positive staff and patients within the health care facility should be identified and notified of exposure. A negative SARS-CoV-2 test indicates only that an individual, unit, or facility did not have detectable virus at the time of testing. People who test negative could have been in the incubation stage of viral infection or the test may fail to detect virus that is present. Thus, repeat testing is recommended if anyone who has tested positive is known to have potentially exposed the group before the start of prevalence testing and/or if anyone tests positive in the first round of testing. Laboratory turnaround time should be short (less than 72 hours) for the survey to be most effective. Additional testing rounds should be conducted with the following considerations: . Only patients and staff who tested negative or who were eligible but not tested in the previous round should be included in subsequent rounds of testing. Repeat testing every three to seven days until 14 days have passed since the last exposure to a person who tested positive for COVID-19. This series of rounds is called a PPS cycle. The interval between repeated testing may be longer or shorter, depending on the expected extent of transmission and the facility’s testing capacity and ability to divert staff to help with testing while still performing other critical infection prevention and control measures. Using a shorter interval (e.g., three days) early in the testing cycle (i.e., in the first two weeks) will help the facility identify and isolate additional cases more quickly. The interval between testing rounds can be lengthened (e.g., to seven days) after the first two weeks. Patients who test positive should be identified immediately for implementation of transmission-based precautions, isolation, and placing in cohorts. Staff who test positive should be excluded from work. In the presence of high rates of community transmission, later testing rounds could identify staff who were exposed out in the community, rather than reflecting transmission within the health care facility. Exposure 4 of 6 CONSIDERATIONS FOR SARS- COV- 2 TESTING IN ACUTE CARE FACILITIES risk assessments and contact tracing can help facilities decide when to end the PPS cycle. In situations of high community transmission, routine approaches to staff testing could be considered. Who should be included in PPS testing? Patients and staff who have had laboratory-confirmed COVID-19 in the last 90 days and who currently do not have symptoms consistent with COVID-19 do not need to be included in testing. Inclusion in PPS should be considered if it has been more than three months since the prior infection. PPS testing of both patients and staff, regardless of vaccination status, is recommended to define the full extent of transmission. This is particularly important in situations where: . Nosocomial spread is suspected. Patients cannot be accommodated in individual rooms. Compliance with social distancing and wearing masks is low (e.g., inpatient psychiatry, behavioral health). There has been broad exposure to presymptomatic or asymptomatic staff who are infected with SARS-CoV-2. Situations where PPS testing may be appropriate for staff only include: . No confirmed or suspected instances of nosocomial transmission. There is a pre-existing testing plan for patients.
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