Routine molecular point-of-care testing for SARS-CoV-2 reduces hospital-acquired COVID-19

Abstract

Objectives Risk of hospital-acquired COVID-19 (HA-COVID-19) infection is increased by cohorting infected and non-infected patients together in assessment areas, whist awaiting laboratory PCR results. Molecular point-of-care tests (mPOCT) reduce time to results and improve patient flow but the impact on HA-COVID-19 is unknown. Methods In this pre and post implementation study patients were evaluated across two time periods: March 1 st to August 13 th 2020, prior to the introduction of mPOCT in medical admissions areas, and 14 th August 2020 to 1 st April 2021, after mPOCT introduction. The primary outcome was proportion of HA-COVID-19 infection among all COVID-19 positive patients. Secondary outcome measures included time to SARS-CoV-2 results, length of time spent in the medical assessment area and comparison of local, regional and national proportions of HA-COVID-19. Results 1988 patients were admitted through the acute medicine admission cohorting area and tested for SARS-CoV-2 prior to introducing mPOCT and 4640 afterwards. Median (IQR) time to SARS-CoV-2 result was 6.5 (2.1-17.9) hours prior to introducing mPOCT and 1.0 (0.8-1.3) hours afterwards (p<0.0001). Median (IQR) duration in the assessment cohort area was 12.0 (4.8-20.6) hours prior to introduction of POCT and 3.2 (2.0-5.6) hours afterwards (p<0.0001). The proportion of hospital-acquired COVID-19 cases was 108 (16.5%) of 654 prior to introducing mPOCT compared with 168 (9.4%) of 1782 afterwards, (HR 0.55, 95%CI 0.43-0.70; p<0.0001). In the period following the introduction of mPOCT up to 1 st April 2021 the median proportion of HA-COVID-19 was 13.6% (95%CI 8.2% - 18.9%) locally, compared with 43.8% (95%CI 37.8%-49.9%) for all acute NHS trusts regionally and 30.9% (95%CI 28.4%-33.5%) for all NHS trusts nationally, Conclusions Routine mPOCT for SARS-CoV-2 was associated with reduced time to results, time spent in admission cohort areas, and hospital-acquired COVID-19, compared to laboratory PCR.

Point-of-Care Testing for SARS-CoV-2: A Prospective Study in a Primary Health Centre

“…In fact, our results showed that a patient in this group required almost 25 min less than a patient in G1. Routine molecular POCT for SARS-CoV-2 was associated with a reduction in time to results and time spent in admission cohort areas compared to laboratory PCR [18]. An active transition from routine diagnostic laboratories to the realm of high-sensitivity molecular diagnostics can significantly increase the efficiency and responsiveness of POCT and facilitate the management of COVID-19 in multiple settings [19].…”

Impact of Fast SARS-CoV-2 Molecular Point-Of-Care Testing on Patients’ Length of Stay in an Emergency Department

“…Reducing the time of infected individuals in emergency wards could also limit the risks of nosocomial transmission ( 15 , 17 , 18 ). A recent study using another molecular POCT showed that its implementation in the ED was associated with a significant reduction in the rate of hospital-acquired COVID-19 cases ( 19 ).…”

Distribution of Viral Respiratory Infections during the COVID-19 Pandemic Using the FilmArray Respiratory Panel

“…Moreover, Tazi S et al [ 31 ] showed that the estimated sensitivity and specificity of FilmArray, compared with the MAScIR SARS-CoV-2 M kit 2.0, were 100% and 79.2%, respectively. Recently, Livingstone et al [ 58 ] showed that the application of FilmArray TM RP 2.1 assay for COVID-19 remarkably reduced the time to obtain results spent on assessment cohort wards and the proportion of hospital-acquired COVID-19 infection. The authors concluded that the routine use of molecular point-of-care testing may become the standard of care in hospital admission procedures.…”