The Society for Healthcare Epidemiology of America, a professional organization of doctors and epidemiologists that specialize in preventing infection in health care settings, has released new guidelines for COVID-19 screening of prospective patients.

“We’re at the end of three years since COVID emerged,” said Dr. Thomas Talbot, chief hospital epidemiologist at Vanderbilt University Medical Center and co-author of the recommendations. “With the luxury of time there have been changes to the risks to workers and patients … and really to the utility of interventions.”

At this point, Talbot said, universal screening is not recommended over strengthening other infection prevention controls. He explained that screening patients without symptoms doesn’t catch many COVID-19 infections and comes with several drawbacks for health care cost and patient care.

“Testing folks who are asymptomatic when they get admitted to the hospital or before a procedure was put in place by a lot of institutions, including my own,” Talbot said. “But over the past three years, we’ve seen very little data that this kind of testing will prevent the spread of the virus. Instead, we’ve seen that it’s very costly.”

In particular, universal screening before short, simple surgical procedures can disrupt the health care of patients who aren’t contagious, Talbot said.

“Rather than testing everyone, you could heighten your precautions,” Talbot said. That would vary by hospital, he said, but would involve improving ventilation, cleaning, masking patients and staff, and isolating confirmed patients with COVID-19. “Instead of leaning on this intervention, strengthen your other interventions if you have a high risk based on your own risk assessment.”

The recommendations point out that if a hospital or health care setting cannot improve other areas of protection, they can consider leaving this sort of testing in place.

While the Centers for Disease Control and Prevention has yet to respond, their guidance may change in the coming months as the COVID-19 pandemic continues to evolve. Current CDC guidelines leave pre-symptomatic and asymptomatic screening at the discretion of all health care facilities but nursing homes. 

“It’s important to note that the Centers for Disease Control and Prevention does not recommend pre-procedural or hospital admission testing,” Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, wrote in an email to CT Insider. “Admission screening is recommended in long-term care facilities in conjunction with the levels of community transmission.”

Local hospitals have been continuously reevaluating their screening policies during the pandemic. Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare, said that it’s possible that not every hospital in the state could relax asymptomatic testing due to space constraints.

“They acknowledge in the study that their recommendations are not a one-size fits all,” Wu said of the society’s guidance. “Each facility will have to handle it differently because they may not have all these layers of protection in place.”

He said Hartford HealthCare had already stopped doing pre-surgical screening. Wu said he was not sure what changes were coming for Hartford HealthCare’s policies or when. Screening before hospital admission at Hartford HealthCare wouldn’t be ending soon, he said.

“We’re like a big boat,” Wu said. “We’re just not going to make quick changes.”

Yale New Haven Hospital told CT Insider that the hospital had already begun scaling back screening for COVID for non-surgical procedures and in certain ambulatory surgical centers.

“Over the coming weeks and months, we will continue to assess how COVID is being spread within our communities and the frequency for which we are identifying COVID among our patients,” wrote Dr. Richard Martinello, medical director for Infection Prevention at Yale New Haven Health. “And we will be considering when to discontinue testing for these groups.”

Even though guidance might change for hospitals, protecting yourself this holiday season is the same as it ever was. Stay home if you’re sick. Masking can prevent spreading illness. Vaccines for flu and COVID-19 are still excellent ways to protect yourself this winter.

“We are in a far different place with this pandemic than we were in 2020,” wrote Juthani. “Multiple layers of infection control are readily available, including personal protective equipment and source control along with improved ventilation, environmental cleaning, and vaccines. The resource-intensive strategy of routine asymptomatic admission screening is less likely to provide additional benefit when other infection control strategies are emphasized and strengthened.”

 

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