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Coronavirus Illness 2019 (COVID-19)

Observe: This doc is meant to supply steerage on the suitable use of testing amongst nursing dwelling residents and doesn’t handle cost 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 dwelling residents are at excessive danger for an infection, critical sickness, and loss of life 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 approved nucleic acid or antigen detection assays, is a crucial addition to different an infection prevention and management (IPC) suggestions aimed toward stopping SARS-CoV-2 from getting into nursing properties, detecting circumstances shortly, and stopping transmission.  This guideline relies on at the moment obtainable details about COVID-19 and shall be refined and up to date as extra info turns into obtainable.

Testing carried out at nursing properties needs to be carried out along with beneficial IPC measures. Services ought to have a plan for testing residents for SARS-CoV-2.  Extra details about the parts of the testing plan can be found within the CDC steerage titled  Making ready for COVID-19 in Nursing Properties.

Testing practices ought to purpose for fast turnaround occasions (e.g., lower than 24 hours) so as to facilitate efficient interventions. Testing the identical resident greater than as soon as in a 24-hour interval shouldn’t be beneficial.  Antibody (serologic) check outcomes typically 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.

Whereas this steerage focuses on testing in nursing properties, a number of of the suggestions comparable 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 dwelling amenities, intermediate care amenities for people with mental disabilities, establishments for psychological illness, and psychiatric residential therapy amenities).

For extra steerage on testing, discuss with the Steering for SARS-CoV-2 Level-of-Care Testing. For extra steerage addressing different non-healthcare settings, discuss with the CDC steerage addressing Communities, Faculties, Workplaces and Occasions. Steering for testing healthcare personnel (HCP) is accessible within the Interim Steering on Testing Healthcare Personnel for SARS-CoV-2.

Diagnostic Testing

Testing residents with indicators or signs of COVID-19

  • At the very least every day, take the temperature of all residents and ask them if they’ve any COVID-19 signs. Carry out 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 signs per COVID-19 and whether or not the resident needs to be examined. People with COVID-19 could not present widespread signs comparable to fever or respiratory signs.  Some could current with solely gentle signs or different much less widespread signs.
    • Clinicians are inspired to contemplate testing for different causes of respiratory sickness, comparable 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)

  • Carry out expanded viral testing of all residents within the nursing dwelling 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 dwelling, 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 establish contaminated residents shortly, so as to help of their scientific administration and permit fast implementation of IPC interventions (e.g., isolation, cohorting, use of non-public protecting gear) to stop SARS-CoV-2 transmission.
    • When endeavor facility-wide viral testing, facility management ought to count on to establish a number of asymptomatic and pre-symptomatic residents with SARS-CoV-2 an infection and be ready to cohort residents. See Public Well being Response to COVID-19 in Nursing Properties for extra particulars.
    • If viral testing capability is restricted, CDC suggests first directing testing to residents who’re shut contacts (e.g., on the identical unit or flooring of a brand new confirmed case or cared for by contaminated HCP).
    • See Concerns for Performing Facility-wide SARS-CoV-2 Testing in Nursing Properties for added particulars.

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

  • Carry out preliminary viral testing of every resident in a nursing dwelling as a part of the beneficial reopening course ofpdf icon.
    • In any nursing dwelling, preliminary viral testing of every resident (who shouldn’t be recognized to have beforehand been recognized with COVID-19) is beneficial due to the excessive chance 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

  • A test-based technique, which requires serial exams and enchancment of signs, may very well be thought-about for discontinuing Transmission-Based mostly Precautions sooner than the symptom-based technique. Nonetheless, most often, the test-based technique leads to extended isolation of residents who proceed to shed detectable SARS-CoV-2 RNA however are not infectious. A test-based technique may be thought-about for some residents (e.g., those that are severely immunocompromised) in session with native infectious illnesses consultants if considerations exist for the resident being infectious for greater than 20 days. In all different circumstances, the symptom-based technique needs to be used to find out when to discontinue Transmission-Based mostly Precautions.

Repeat Testing in Coordination with the Well being Division

Non-diagnostic testing of asymptomatic residents with out recognized or suspected publicity to a person contaminated with SARS-CoV-2 (other than 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 under.  Repeat testing needs to be coordinated with the native, territorial, or state well being division.
  • Proceed repeat viral testing of all beforehand adverse residents, typically each 3 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 no less than 14 days since the latest optimistic outcome. This follow-up viral testing can help within the scientific administration of contaminated residents and within the implementation of an infection management interventions to stop SARS-CoV-2 transmission.
    • If viral check capability is restricted, 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 big amenities with restricted viral check capability, testing solely residents on affected models may very well be thought-about, particularly if facility-wide repeat viral testing demonstrates no transmission past a restricted variety of models.
  • Healthcare personnel (HCP): HCP embody, however should 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 indirectly concerned in affected person care however who may very well be uncovered to infectious brokers that may be transmitted within the healthcare setting (e.g., clerical, dietary, environmental companies, laundry, safety, engineering and amenities administration, administrative, billing, and volunteer personnel). For this steerage, HCP doesn’t embody scientific laboratory personnel.
  • Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated within the nursing dwelling. It doesn’t discuss with the next:
    • Residents who have been recognized to have COVID-19 on admission to the power and have been positioned into acceptable Transmission-Based mostly Precautions to stop transmission to others within the facility.
    • Residents who have been positioned into Transmission-Based mostly Precautions on admission and developed SARS-CoV-2 an infection inside 14 days after admission.

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