FAQ RE: DISCONTINUATION OF UNIVERSAL COVID-19 ADMISSION TESTING

COVID-19 Admission Testing

** Please note that information about COVID-19 and testing can change quickly depending on community spread and severity of variants. We will continue to make updates as more information is available. Thank you. **

As of April 20, Denver Health will no longer require universal admission testing for COVID-19. Patients with clinical suspicion of COVID-19 (for example, symptoms of pneumonia or upper respiratory tract infections) should be tested prior to admission, but those without symptoms of COVID-19 will no longer be tested.

Why is Denver Health removing universal COVID-19 admission testing?

The rate of COVID-19 in the community is quite low at the current time. Therefore, the chances of someone being asymptomatic and positive are also low. Our internal data for March 2022 supports that there are very few asymptomatic admitted patients who are positive for COVID-19. There are downsides to universal COVID-19 admission testing, most notably longer emergency department lengths of stay.

Will staff be at increased risk of contracting COVID-19 from patients?

Denver Health will continue to require medical masks for patient care. While an N95 mask is recommended for the care of patients with COVID-19, the Infectious Diseases Society of America states that medical masks are also effective at preventing COVID-19 transmission.

Will Denver Health consider reinstituting universal COVID-19 testing for admitted patients if COVID-19 rates increase?

We will consider many factors in the coming weeks and months. Some of these factors may include the rate of COVID-19 in the community, the percentage of our population who is immune to COVID-19, and the severity of the circulating COVID-19 strain.

Can we test patients for COVID-19 at admission to the hospital?

Patients with symptoms of COVID-19 should be tested at admission to the hospital. In general, those who do not have symptoms of COVID-19 should not be tested.

How can we determine if someone has symptoms of COVID-19 if they have altered mental status or are intubated?

If you cannot determine whether a patient has symptoms of COVID-19, then the clinician may use judgment in whether results of a COVID-19 test will change the management of the patient. However, the patient can be assigned a bed and moved to the appropriate hospital unit while the test is pending as the likelihood of a positive test is quite low at the current time. The appropriate isolation for a patient with unknown symptoms of COVID-19 is standard precautions; specialized respiratory isolation should only be initiated if the test were to be positive.

Is Denver Health performing COVID-19 tests prior to invasive procedures?

In general, patients undergoing invasive procedures do not require a COVID-19 test prior to the procedure. There may be certain situations where the procedure would be of high risk to someone with active COVID-19 such as lobectomy, chest surgery, or VATS. The decision to test prior to an invasive lung procedure is handled on a case-by-case basis.

If a patient has asymptomatic COVID-19 infection, is their roommate at risk of contracting COVID-19?

Yes, a roommate would be at risk of contracting COVID-19 if someone with asymptomatic COVID-19 is in their room. However, the risk of this occurring is quite low at the current time because COVID-19 is not circulating at high levels in the community and because over 90% of Denver’s population is immune to COVID-19 at the current time from vaccination, boosters, and recent infection.

Will staff be at risk of contracting COVID-19 if an inpatient with asymptomatic infection is placed into a standard pressure room?

No, staff are not at increased risk of contracting COVID-19 if a patient with asymptomatic COVID-19 is placed into a standard pressure room. A recent study was performed to determine the rate of COVID-19 infection in staff in two similar hospitals. One of the hospitals kept over 95% of patients with COVID-19 in negative pressure isolation whereas the other hospital kept only 25% of patients with COVID-19 in negative pressure isolation. The rate of staff infections was approximately 2% in both hospitals.

If we need to do an aerosol-generating procedure in a patient with an unknown COVID-19 status, what precautions should we take?

An N95 mask or PAPR is recommended for select aerosol-generating procedures, regardless of the COVID-19 status of a patient (see Table 1 below).

Research in COVID-19 has shown that certain activities and healthcare interventions may produce smaller aerosolized particles that can remain airborne and possibly penetrate through a medical mask. Examples of these activities and healthcare interventions include coughing, singing, heated high flow oxygen administration, and more. The eclectic and expansive activities and procedures that could generate aerosolized particles has led to the implementation of N95 use for all COVID-19 patients, regardless of clinical status.

While many activities and healthcare interventions may create aerosols, there are only a few aerosol-generating procedures that have been shown to be high risk for healthcare workers. In a meta-analysis of SARS-CoV-1 risk in healthcare workers, the authors found that intubation, non-invasive ventilation, tracheotomy, and manual ventilation before intubation were associated with higher risk of SARS-CoV-1 to HCW and that tracheal aspiration, suction, bronchoscopy, nebs, high flow O2 were not associated with higher risk of SARS-CoV-1 to HCW. Using this literature, the CDC and WHO have compiled a list of aerosol-generating procedures (Table 1).

Table 1. CDC and WHO lists of aerosol-generating procedures

CDC (COVID)

CDC (Influenza)

WHO (COVID)

Autopsies

X

Bronchoscopy

X

X

X

Cardiopulmonary Resuscitation (CPR)

X

X

X

Endotracheal intubation/extubation

X

X

X

Manual Ventilation

X

X

Non-Invasive ventilation (e.g. BiPAP, CPAP)

X

X

Open suctioning of airways

X

X

Sputum induction

X

X

Tracheotomy

X

1. Centers for Disease Control and Prevention. Health care Infection Prevention and Control FAQs for COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Infection-Control

2. Centers for Disease Control and Prevention. Prevention Strategies for Seasonal Influenza in Health care Settings. Available at: https://www.cdc.gov/flu/professionals/infectioncontrol/health caresettings.htm

3. World Health Organization. Advice on the use of masks in the context of COVID-19. Available at:https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-health care-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

4. World Health Organization. Epidemic- and pandemic-prone acute respiratory diseases - Infection prevention and control in health care. Available at: https://www.who.int/csr/resources/publications/aidememoireepidemicpandemid/en/

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