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Coronavirus Illness 2019 (COVID-19)

Revisions have been made on October 16, 2020, to replicate the next:

Revisions have been made on September 10, 2020, to replicate the next:

Revisions have been made on July 17, 2020, to replicate the next:

  • Up to date “Testing to find out decision of an infection” so as to add details about people who find themselves severely immunocompromised.

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

Notice: This doc is meant to supply steering on the suitable use of testing amongst nursing dwelling residents and doesn’t tackle fee choices 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 dying 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 instances shortly, and stopping transmission.  This guideline is predicated on at present accessible details about COVID-19 and will likely be refined and up to date as extra info turns into accessible.

Testing performed at nursing properties needs to be carried out along with really useful 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 steering titled  Getting ready for COVID-19 in Nursing Houses.

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

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

For extra steering on testing, seek advice from the Steering for SARS-CoV-2 Level-of-Care Testing. For extra steering addressing different non-healthcare settings, seek advice from the CDC steering addressing Communities, Faculties, Workplaces and Occasions. Steering for testing healthcare personnel (HCP) is offered 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 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 might not present widespread signs corresponding to fever or respiratory signs.  Some might current with solely gentle signs or different much less widespread signs.
    • Clinicians are inspired to think about testing for different causes of respiratory sickness, corresponding 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’s an outbreak within the facility)

  • Carry out expanded viral testing of all residents within the nursing dwelling if there’s 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 of 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 determine contaminated residents shortly, with a purpose to help of their medical administration and permit fast implementation of IPC interventions (e.g., isolation, cohorting, use of non-public protecting gear) to forestall SARS-CoV-2 transmission.
    • When endeavor facility-wide viral testing, facility management ought to anticipate to determine 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 Houses 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 Issues for Performing Facility-wide SARS-CoV-2 Testing in Nursing Houses 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 really useful reopening course of

  • Carry out preliminary viral testing of every resident in a nursing dwelling as a part of the really useful reopening course ofpdf icon.
    • In any nursing dwelling, preliminary viral testing of every resident (who shouldn’t be recognized to have beforehand been identified with COVID-19) is really useful 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 choices, an infection management interventions, and placement choices (e.g., cohorting choices) related to that resident.

Testing to find out decision of an infection

  • A test-based technique, which requires serial checks and enchancment of signs, may very well be thought of for discontinuing Transmission-Based mostly Precautions sooner than the symptom-based technique. Nonetheless, usually, the test-based technique leads to extended isolation of residents who proceed to shed detectable SARS-CoV-2 RNA however are now not infectious. A test-based technique may be thought of for some residents (e.g., those that are severely immunocompromised) in session with native infectious illnesses specialists 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 beneath.  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 instances of SARS-CoV-2 an infection amongst residents or HCP for a interval of a minimum of 14 days since the latest optimistic consequence. This follow-up viral testing can help within the medical administration of contaminated residents and within the implementation of an infection management interventions to forestall 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 ability (e.g., for outpatient dialysis) or have recognized publicity to a case (e.g., roommates of instances or these cared for by a HCP with confirmed SARS-CoV-2 an infection). For big services with restricted viral take a look at capability, testing solely residents on affected items may very well be thought of, particularly if facility-wide repeat viral testing demonstrates no transmission past a restricted variety of items.
  • Healthcare personnel (HCP): HCP embody, however are usually 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 may very well be uncovered to infectious brokers that may be transmitted within the healthcare setting (e.g., clerical, dietary, environmental providers, laundry, safety, engineering and services administration, administrative, billing, and volunteer personnel). For this steering, HCP doesn’t embody medical laboratory personnel.
  • Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated within the nursing dwelling. It doesn’t seek advice from the next:
    • Residents who have been recognized to have COVID-19 on admission to the ability and have been positioned into applicable Transmission-Based mostly Precautions to forestall 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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