Background
We implemented a pre-procedural SARS-CoV-2 screening initiative designed to sustain healthcare during a time when the extent of SARS-CoV-2 infection was unknown.
Methods
Prospective study of patients undergoing procedures at 3 academic hospitals in Pittsburgh, PA (April 21-June 11) and 19 community hospitals across Middle/Western Pennsylvania and Southwestern New York (May 1-June 11). Patients at academic hospitals underwent symptom screening ≤7 days pre-procedure, then SARS-CoV-2 nasopharyngeal PCR testing 1-4 days pre-procedure. A subset also underwent day-of-procedure testing. Community hospital patients underwent testing per local protocols. We report SARS-CoV-2 PCR-positivity rates, impact, and barriers to testing encountered through June 11. PCR-positivity rates of optional pre-procedural SARS-CoV-2 testing for two consecutive periods following the screening initiative are also reported.
Results
Of 5881 eligible academic hospitals patients, 2415 (41.1%) were tested (April 21-June 11). Lack of interest, distance, self-isolation, and nursing home/incarceration status were barriers. There were 11 PCR-positive patients (10 asymptomatic) among 10,539 patients tested (0.10%, 95% CI 0.05-0.19): 3/2,415 (0.12%, 95% CI 0.02-0.36) and 8/8,124 (0.10%, 95 CI% 0.04-0.19) at academic and community hospitals, respectively. Procedures were performed as scheduled in 40% (4/10) of asymptomatic PCR-positive patients. Positivity increased during subsequent COVID-19 surges: 54/34,948 (0.15%, 95% CI 0.12–0.20) and 101/24,741 (0.41%, 95% CI 0.33–0.50) PCR-positive patients between June 12-September 10 and September 11–December 15, respectively (p<0.0001).
Conclusions
Implementing pre-procedural PCR testing was complex and revealed low infection rates (0.24% overall), which increased during COVID-19 surges. Additional studies are needed to define the COVID-19 prevalence threshold at which universal pre-procedural screening is warranted.