SHEA advises against COVID screening of patients with no symptoms


Center for Infectious Disease Research and Policy.

Mary Van Beusekom, MS.

Today the Society for Healthcare Epidemiology of America (SHEA) published a recommendation against universal COVID-19 screening of asymptomatic patients before healthcare facility entry and surgical procedures.

In the guidance, published in Infection Control & Hospital Epidemiology, members of SHEA’s board of directors said that testing asymptomatic patients “has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls.”

Reduced patient access, high cost

Facilities that require a negative COVID-19 test before providing care may also unintentionally reduce access for disadvantaged groups who already have limited access to care and testing, the authors said. They also cited the unlikely benefit of presurgical screening, a setting in which other infection-prevention measures are already in place.

The guidance notes the logistical challenges and costs of screening programs and data on the lack of substantial aerosol production during elective controlled intubation, extubation, and other procedures. It also cites research showing that COVID-19 testing added 1.9 hours to emergency department visits in one health system and cost a hospital more than $12,500 to identify one asymptomatic infection.

“The adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention,” they wrote. They added that SHEA “recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities.”

SHEA acknowledged that COVID-19 screening at facility admission may help curb spread in areas with limited infection-control strategies, such as behavioral health, congregate care, or shared patient rooms.

The adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention.

Lead author Thomas Talbot, MD, MPH, of Vanderbilt University, said such screenings carry the risk of harms from delays in procedures, patient transfers, and burdens on lab capacity and staff. “Since some tests can detect residual virus for a long period, patients who test positive may not be contagious,” he said in a SHEA press release.

Rather, healthcare facilities should consider the use of N95 respirators for staff performing high-risk procedures, clinician screening, reduction of shared patient spaces, and better ventilation, they said.