SARS-CoV-2 surged in hospitals after end of universal screening
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Key takeaways:
- Ending asymptomatic SARS-CoV-2 screening at hospital admission was associated with increases in hospital-onset cases in England and Scotland.
- Rates increased between delta and omicron waves.
SEATTLE — New hospital-onset cases of SARS-CoV-2 infection outpaced community-onset cases after England and Scotland stopped requiring hospitals to test asymptomatic patients at admission, researchers reported.
“The question motivating the study is: Should we stop universal screening of all patients admitted for COVID-19? This has become a hot topic,” Theodore Pak, MD, PhD, an infectious diseases fellow at Massachusetts General Hospital, said during a presentation at the Society for Healthcare Epidemiology of America Spring Conference.
A recent position paper published by the SHEA board of trustees in November 2022 addressed challenges and considerations regarding universal SARS-CoV-2 screening, a practice that has been in place in many hospitals in the United States since early in the pandemic. In the paper, the authors recommended that facilities no longer perform procedure, pre-procedure and pre-admission SARS-CoV-2 testing for asymptomatic patients, Pak explained.
“Setting aside the conclusion of the position paper, [there are] limited data on this topic — particularly its impact,” he said.
In their abstract, Pak and colleagues noted that universal SARS-CoV-2 screening has been questioned because of its strain on resources, impact on timely care and the lack of data on its impact on hospital-onset infections.
For their study, the researchers used data from the National Health Service England and Public Health Scotland to assess the impact of the end of universal admission testing for SARS-CoV-2 in those two countries on Aug. 31, 2022.
They defined hospital-onset SARS-CoV-2 infection as cases diagnosed more than 7 days after admission between July 1, 2021, and Dec. 16, 2022. They calculated the weekly ratio between hospital-onset vs. community-onset SARS-CoV-2 admissions to uncover any changes associated with stopping universal admission testing.
They divided the results into three periods — delta dominance with admission testing, omicron dominance with admission testing, and omicron dominance without admission testing.
Throughout the study period, there were a total of 518,379 COVID-19 admissions in England — including 398,264 community-onset and 120,115 hospital-onset infections — and 46,517 COVID-19 admissions in Scotland — including 34,183 community-onset and 12,334 hospital-onset infections.
According to the study, the mean weekly ratio of new hospital-onset infections vs. community-onset admissions in England increased from 0.12 during the delta-dominant period to 0.33 during omicron, and then increased again to 0.48 after universal admission testing was stopped. Similar results were seen in Scotland, where the mean weekly ratio rose from 0.11 to 0.43 and then again to 0.89.
The researchers noted that the relative increases in cases from the delta to omicron period in England and Scotland (113% and 92%) and after the end of admission testing (32% and 72%) were “significant.”
“Stopping asymptomatic screening of hospitalized patients in two national health systems was associated with significant increases in hospital-onset SARS-CoV-2 infections,” Pak and colleagues wrote. “Hospitals should exercise caution when considering reductions in SARS-CoV-2 admission screening.”
References:
- Pak T, et al. Association between stopping universal SARS-CoV-2 admission testing and hospital-onset SARS-CoV-2 in England and Scotland. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; April 11-14, 2023; Seattle.
- Pre-procedure and pre-admission COVID-19 testing no longer recommended for asymptomatic patients. https://shea-online.org/pre-procedure-and-pre-admission-covid-19-testing-no-longer-recommended-for-asymptomatic-patients/. Posted Dec. 21, 2022. Accessed April 12, 2023.
- Talbot TR, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2022.295.
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Pak T, et al. Association between stopping universal SARS-CoV-2 admission testing and hospital-onset SARS-CoV-2 in England and Scotland. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; April 11-14, 2023; Seattle.
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