Universal admission laboratory screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic infection across a large health system

Abstract

Background: Admission laboratory screening for asymptomatic coronavirus disease 2019 (COVID-19) has been utilized to mitigate healthcare-associated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission. An understanding of the impact of such testing across a variety of patient populations is needed. Methods: SARS-CoV-2 nucleic acid amplification admission testing results for all asymptomatic patients across 4 distinct inpatient facilities between April 20, 2020, and June 14, 2021, were analyzed. Positivity rates and the number needed to test (NNT) to identify 1 asymptomatic infected patient were calculated. Admission results were compared to COVID-19 community incidence rates for the system’s surrounding metropolitan service area. Using a national survey of hospital epidemiologists, a clinically meaningful NNT of 1:100 was identified. Results: In total, 51,187 tests were collected (positivity rate, 1.8%). During periods of high transmission, the NNT met the clinically relevant threshold in all populations. The NNT approached or met the threshold for most locations during periods of lower transmission. For all transmission levels, the NNT for fully vaccinated patients did not meet the threshold. Conclusions: Implementing an asymptomatic patient admission testing program can provide clinically relevant data based on the NNT, even during periods of lower transmission and among different patient populations. Limiting admission testing to non–fully vaccinated patients during periods of lower transmission may be a strategy to address resource concerns around this practice. Although the impact of such testing on healthcare-associated COVID-19 among patients and healthcare workers could not be clearly determined, these data provide important information as facilities weigh the costs and benefits of such testing.

Community asymptomatic COVID-19 laboratory testing related hospital admission

“…Hospital admission laboratory screening for asymptomatic COVID-19 has been used in COVID-19 pandemic management, particularly mitigation of the healthcare staff, 1,2 whereas more than half of community-COVID-19 transmission may originate from asymptomatic persons. 1…”

More harm than good? Potential benefits and unintended consequences associated with screening asymptomatic hospital admissions for severe acute respiratory syndrome coronavirus 2

“…To the Editor-During the coronavirus disease 2019 (COVID-19) pandemic, screening of asymptomatic patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of healthcare facility admission has often been used in an effort to reduce the risk of nosocomial transmission. [1][2][3] However, the Society for Healthcare Epidemiology of America recently recommended against routine use of asymptomatic screening in healthcare facilities, including admission screening. 4 Such testing is of unclear benefit when other control measures are in place and may result in unintended adverse consequences, including delays in medical care and unnecessary isolation and treatment of noninfectious patients.…”

“…Our findings are consistent with those of previous studies suggesting that asymptomatic admission screening could be beneficial in reducing nosocomial transmission of SARS-CoV-2. [1][2][3] Admission screening detected 9 presymptomatic patients and 15 asymptomatic patients with Ct values <35, including 11 with Ct value <30. Such patients may contribute substantially to transmission, including to roommates in healthcare facilities.…”