Testing for Coronavirus (COVID-19) in Nursing Homes

Revisions had been made on July 1, 2020, to replicate the next:

Note: This doc is meant to offer steering on the suitable use of testing amongst nursing residence residents and doesn’t dictate the dedication of fee selections or insurance coverage protection of such testing, besides as could also be in any other case referenced (or prescribed) by one other entity or federal or state company.

Nursing residence residents are at excessive danger for an infection, critical sickness, and demise from COVID-19. Testing for SARS-CoV-2, the virus that causes COVID-19, in respiratory specimens can detect present infections (referred to right here as viral testing) amongst residents in nursing properties. Viral testing of residents in nursing properties, with licensed nucleic acid or antigen detection assays, is a crucial addition to different infection prevention and control (IPC) suggestions aimed toward stopping SARS-CoV-2 from coming into nursing properties, detecting circumstances rapidly, and stopping transmission.  This guideline relies on at the moment obtainable details about COVID-19 and will likely be refined and up to date as extra data turns into obtainable.

Testing carried out at nursing properties needs to be applied along with recommended IPC measures. Facilities ought to have a plan for testing residents for SARS-CoV-2.  Additional details about the parts of the testing plan can be found within the CDC steering titled  Preparing for COVID-19 in Nursing Homes.

Testing practices ought to purpose for speedy turnaround instances (e.g., lower than 24 hours) to be able to facilitate efficient interventions. Testing the identical resident greater than as soon as in a 24-hour interval isn’t advisable.  Antibody (serologic) take a look at outcomes usually shouldn’t be used as the only real foundation to diagnose an lively SARS-CoV-2 an infection and shouldn’t be used to tell IPC actions.

While this steering focuses on testing in nursing properties, a number of of the suggestions similar to testing residents with indicators or signs of COVID-19 and testing asymptomatic shut contacts also needs to be utilized to different long-term care amenities (e.g., assisted residing amenities, intermediate care amenities for people with mental disabilities, establishments for psychological illness, and psychiatric residential remedy amenities).

For further steering addressing different non-healthcare settings, check with the CDC steering addressing Communities, Schools, Workplaces and Events. Guidance for testing healthcare personnel (HCP) is obtainable within the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2.

Diagnostic Testing

Testing residents with indicators or signs of COVID-19.

  • At least day by day, take the temperature of all residents and ask them if they’ve any COVID-19 symptoms. Perform viral testing of any resident who has indicators or signs of COVID-19.
    • Clinicians ought to use their judgment to find out if a resident has indicators or symptoms in line with COVID-19 and whether or not the resident needs to be examined. Individuals with COVID-19 might not present frequent signs similar to fever or respiratory signs.  Some might current with solely gentle signs or other less common symptoms.
    • Clinicians are inspired to contemplate testing for different causes of respiratory sickness, similar to influenza, along with testing for SARS-CoV-2.

Testing asymptomatic residents with recognized or suspected publicity to a person contaminated with SARS-CoV-2, together with shut and expanded contacts (e.g., there may be an outbreak within the facility).

  • Perform expanded viral testing of all residents within the nursing residence if there may be an outbreak within the facility (i.e., a brand new SARS-CoV-2 an infection in any HCP or any nursing home-onset SARS-CoV-2 an infection in a resident).
    • A single new case of SARS-CoV-2 an infection in any HCP or a nursing home-onset SARS-CoV-2 an infection in a resident needs to be thought-about an outbreak. When one case is detected in a nursing residence, there are sometimes different residents and HCP who’re contaminated with SARS-CoV-2 who can proceed to unfold the an infection, even when they’re asymptomatic. Performing viral testing of all residents as quickly as there’s a new confirmed case within the facility will determine contaminated residents rapidly, to be able to help of their medical administration and permit speedy implementation of IPC interventions (e.g., isolation, cohorting, use of private protecting gear) to stop SARS-CoV-2 transmission.
    • When endeavor facility-wide viral testing, facility management ought to count on to determine a number of asymptomatic and pre-symptomatic residents with SARS-CoV-2 an infection and be ready to cohort residents. See Public Health Response to COVID-19 in Nursing Homes for extra particulars.
    • If viral testing capability is proscribed, CDC suggests first directing testing to residents who’re shut contacts (e.g., on the identical unit or ground of a brand new confirmed case or cared for by contaminated HCP).
    • See Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes for extra particulars.

Initial (baseline) testing of asymptomatic residents with out recognized or suspected publicity to a person contaminated with SARS-CoV-2 is a part of the advisable reopening course of.

  • Perform preliminary viral testing of every resident in a nursing residence as a part of the advisable reopening processpdf iconexternal icon.
    • In any nursing residence, preliminary viral testing of every resident (who isn’t recognized to have beforehand been identified with COVID-19) is advisable due to the excessive probability of publicity throughout a pandemic, transmissibility of SARS-CoV-2, and the danger of problems amongst residents following an infection.
    • The outcomes of viral testing inform care selections, an infection management interventions, and placement selections (e.g., cohorting selections) related to that resident.

Testing to find out decision of an infection.

Repeat Testing in Coordination with the Health Department

Non-diagnostic testing of asymptomatic residents with out recognized or suspected publicity to a person contaminated with SARS-CoV-2 (aside from the preliminary testing referenced above).

  • After initially performing viral testing of all residents in response to an outbreak, CDC recommends repeat testing to make sure there are not any new infections amongst residents and HCP and that transmission has been terminated as described beneath.  Repeat testing needs to be coordinated with the native, territorial, or state well being division.
  • Continue repeat viral testing of all beforehand damaging residents, usually each three days to 7 days, till the testing identifies no new circumstances of SARS-CoV-2 an infection amongst residents or HCP for a interval of at the very least 14 days since the newest optimistic outcome. This follow-up viral testing can help within the medical administration of contaminated residents and within the implementation of an infection management interventions to stop SARS-CoV-2 transmission.
    • If viral take a look at capability is proscribed, CDC suggests directing repeat rounds of testing to residents who depart and return to the power (e.g., for outpatient dialysis) or have recognized publicity to a case (e.g., roommates of circumstances or these cared for by a HCP with confirmed SARS-CoV-2 an infection). For massive amenities with restricted viral take a look at capability, testing solely residents on affected items might be thought-about, particularly if facility-wide repeat viral testing demonstrates no transmission past a restricted variety of items.
  • Healthcare personnel (HCP): HCP embrace, however usually are not restricted to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, feeding assistants, college students and trainees, contractual HCP not employed by the healthcare facility, and individuals circuitously concerned in affected person care however who might be uncovered to infectious brokers that may be transmitted within the healthcare setting (e.g., clerical, dietary, environmental providers, laundry, safety, engineering and amenities administration, administrative, billing, and volunteer personnel). For this steering, HCP doesn’t embrace medical laboratory personnel.
  • Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated within the nursing residence. It doesn’t check with the next:
    • Residents who had been recognized to have COVID-19 on admission to the power and had been positioned into acceptable Transmission-Based Precautions to stop transmission to others within the facility.
    • Residents who had been positioned into Transmission-Based Precautions on admission and developed SARS-CoV-2 an infection inside 14 days after admission.

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