Hospitals can stop testing for COVID-19 in asymptomatic patients, societies say

Multiple medical societies recently updated their recommendations on testing asymptomatic hospital patients for COVID-19.

The Society for Healthcare Epidemiology of America (SHEA) recently recommended against routine universal asymptomatic screening for SARS-CoV-2 in health care facilities, in a Board Commentary published by Infection Control & Hospital Epidemiology on Dec. 21. Preprocedural asymptomatic screening is unlikely to help prevent COVID-19 transmission in health care facilities when other infection prevention strategies are in place, the statement said.

The statement noted that testing of asymptomatic patients has been resource intensive and does not clearly provide benefit beyond other layers of infection prevention. “Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms),” the statement said. “Prior to implementation of a large-scale asymptomatic screening program, strengthening existing layers of protection (eg, move to universal N95 respirator use when performing certain procedures on any patient, active versus passive screening of [health care personnel] for signs of COVID-19, reducing higher-risk unit layouts to remove semiprivate areas, enhanced ventilation) is a more practical and reasonable approach.”

The commentary also outlined challenges and consequences of asymptomatic screening and reviewed data supporting the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures.

The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation also updated their recommendations and endorsed SHEA's guidance. The groups wrote in a Dec. 21 press release that the SHEA recommendations “provide a rationale for considering a move away from universal screening.” In place of the anesthesia groups' previous recommendations to screen patients before nonemergent surgery, they now advise health care facilities to analyze the risks and benefits of preprocedural screening, considering local factors such as patient population, facility physical layout, and community incidence and transmission of COVID-19.

“The recommendations by SHEA should be considered along with these updated recommendations to operationalize a robust and safe perioperative screening and targeted testing program for the benefit of our patients, our healthcare workers, other hospital patients and the public,” the press release said.