Epidemiology group no longer recommends universal asymptomatic COVID screening at healthcare facilities

A major professional organization for healthcare epidemiologists announced Wednesday that it no longer recommends universal COVID-19 screening for asymptomatic patients entering the hospital due to care delays and testing’s “unclear benefit” when layered upon a healthcare facility’s other infection prevention measures.

Members of the Society for Healthcare Epidemiology of America’s (SHEA's) board of directors published the new recommendation Wednesday morning in the organization’s journal, Infection Control & Hospital Epidemiology.

There, they wrote that blanket asymptomatic testing in healthcare facilities “is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission” and “should not be considered a requirement for all patients” if other recommended prevention strategies—such as enhanced cleaning and ventilation, active COVID-19 screening of providers and universal N95 respirator use during certain procedures—are already in place.

“The small benefits that could come from asymptomatic testing at this stage in the pandemic are overridden by potential harms from delays in procedures, delays in patient transfers and strains on laboratory capacity and personnel,” Thomas R. Talbot, M.D., chief hospital epidemiologist at Vanderbilt University Medical Center and a member of the SHEA board of directors, said in a press release. “Since some tests can detect residual virus for a long period, patients who test positive may not be contagious.”

The group backed its decision with studies outlining potential negative impacts from universal asymptomatic screening.

One study found that the screening added 1.89 hours to emergency department stays at an academic health system, while another set among behavioral health patients attributed an average 7.3-hour increase in length of stay to universal admission testing. Other cited data pointed to cost increases, placement of noninfectious patients into isolation precautions, burden on testing facilities and a potential false sense of reduced risk.

Still, the authors wrote that there are situations in which admission screening could be beneficial, such as when facility risk assessments flag ongoing transmission or when dealing with “particularly at-risk populations” such as those admitted to congregate health facilities, behavioral health facilities or transplant units.

“Although it is imperative to prevent healthcare-associated spread of respiratory pathogens, we must critically assess interventions that, when added upon core layers of infection prevention, may not attain the intended impact and may have unintended consequences for patients and [healthcare providers],” the authors wrote in the journal.