Testing Pointers for Nursing Properties

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Revisions had been made on September 10, 2020, to mirror the next:

Revisions had been made on July 17, 2020, to mirror 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 had been made on July 1, 2020, to mirror the next:

Be aware: This doc is meant to offer steering on the suitable use of testing amongst nursing residence residents and doesn’t handle 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 residence residents are at excessive danger for an infection, severe 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 vital addition to different an infection prevention and management (IPC) suggestions aimed toward stopping SARS-CoV-2 from coming into nursing properties, detecting instances shortly, and stopping transmission.  This guideline is predicated on presently out there details about COVID-19 and might be refined and up to date as extra data turns into out there.

Testing carried out at nursing properties needs to be carried out along with really useful IPC measures. Amenities 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  Making ready for COVID-19 in Nursing Properties.

Testing practices ought to intention 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 just isn’t 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 dwelling services, intermediate care services for people with mental disabilities, establishments for psychological illness, and psychiatric residential remedy services).

For extra steering on testing, confer with the Testing Assets for Nursing Properties one-pagerpdf icon. For extra steering addressing different non-healthcare settings, confer with the CDC steering addressing Communities, Colleges, 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

  • A minimum of 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 in keeping with 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 contemplate 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 residence 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-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 establish contaminated residents shortly, to be able to help of their scientific administration and permit speedy implementation of IPC interventions (e.g., isolation, cohorting, use of non-public protecting tools) to forestall SARS-CoV-2 transmission.
    • When endeavor facility-wide viral testing, facility management ought to anticipate 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 proscribed, 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 Issues 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 really useful reopening course of

  • Carry out preliminary viral testing of every resident in a nursing residence as a part of the really useful reopening course ofpdf icon.
    • In any nursing residence, preliminary viral testing of every resident (who just isn’t recognized to have beforehand been identified with COVID-19) is really useful due to the excessive chance of publicity throughout a pandemic, transmissibility of SARS-CoV-2, and the danger of issues 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 exams and enchancment of signs, could possibly be thought-about for discontinuing Transmission-Based mostly Precautions sooner than the symptom-based technique. Nevertheless, typically, the test-based technique ends in extended isolation of residents who proceed to shed detectable SARS-CoV-2 RNA however are not infectious. A test-based technique is also thought-about for some residents (e.g., those that are severely immunocompromised) in session with native infectious ailments 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 under.  Repeat testing needs to be coordinated with the native, territorial, or state well being division.
  • Proceed repeat viral testing of all beforehand unfavourable residents, typically each three 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 not less than 14 days since the newest 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 forestall SARS-CoV-2 transmission.
    • If viral take a look at capability is proscribed, CDC suggests directing repeat rounds of testing to residents who go away 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 giant services with restricted viral take a look at capability, testing solely residents on affected models could possibly be thought-about, particularly if facility-wide repeat viral testing demonstrates no transmission past a restricted variety of models.
  • 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 indirectly concerned in affected person care however who could possibly be uncovered to infectious brokers that may be transmitted within the healthcare setting (e.g., clerical, dietary, environmental companies, laundry, safety, engineering and services administration, administrative, billing, and volunteer personnel). For this steering, HCP doesn’t embrace scientific laboratory personnel.
  • Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated within the nursing residence. It doesn’t confer with the next:
    • Residents who had been recognized to have COVID-19 on admission to the ability and had been positioned into applicable Transmission-Based mostly Precautions to forestall transmission to others within the facility.
    • Residents who had 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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