Duration of Transmission-Based Precautions for Patients Suspected or Confirmed to Have COVID-19
Together, we are dedicated to caring for our patients who are suspected or confirmed to have COVID-19. We have released guidance to provide direction for clinical teams on the considerations necessary to make isolation decisions and the steps that must be taken to safely make any status changes.
This guidance applies to all UMMS facilities where COVID-19 patients are being tested and treated, including ambulatory care settings. These policies have been developed based on guidance from the Centers for Disease Control and Prevention (CDC) and published literature. Local Infection Prevention leaders at each facility should be utilized as a crucial resource for clinical teams.
The algorithms attached to this guidance were updated on August 1, 2022, to allow more timely assessment for possible discontinuation of isolation precautions for COVID-19-positive patients at those facilities utilizing a test-based strategy using antigen tests. With this change, for asymptomatic patients who test positive on routine admission testing, and have no known exposure, providers no longer need to wait until day 6 to begin testing; antigen testing to discontinue isolation precautions can begin immediately. Please review the algorithms attached to the policy for specific clinical guidance for each patient population. Please note: It is critical that any staff performing inpatient antigen testing complete the appropriate training and demonstrate competency beforehand. In the absence of available tests or competent staff to conduct such testing, time-based strategies should be used.
Please see the Policy for Expanded Use of PPE for COVID-19 for additional PPE guidance as determined by the UMMS Tiered Approach.
Click here to view the Duration of Transmission-Based Precautions for Patients Suspected or Confirmed to Have COVID-19.
FAQs
What precautions should be used for patients with a confirmed positive COVID-19 test?
Patients with a confirmed positive COVID-19 test, regardless of whether they are symptomatic or asymptomatic, are considered “COVID-19 Confirmed.” These patients should be treated using COVID-19 precautions, meaning either airborne, droplet and contact precautions.
What is the process and timing to transition a patient out of isolation who originally tested positive for COVID-19?
This policy outlines several strategies and explains when a time-based strategy or a test-based strategy is recommended – which will depend on the severity of the patient’s illness and whether or not they are severely immunosuppressed. Please review the policy in full for testing algorithms and comprehensive guidance on each strategy, including when repeat testing is warranted and additional criteria for determining when a patient may be considered COVID-19 Recovered.
Why are we using antigen tests instead of PCR tests?
While, overall, PCR tests are more sensitive than antigen tests in making a diagnosis of COVID-19, PCR tests can remain positive for weeks to months as they amplify very small quantities of residual genetic material. In contrast, antigen tests tend to be positive in the setting of replicating virus and correlate better with potential infectiousness of an infected individual. For this reason, the use of antigen testing to determine isolation duration is now recommended by the CDC.
How should a previously diagnosed COVID-19 positive patient be handled if they present to the hospital for readmission?
This guidance will vary depending on whether the patient has been determined to be COVID-19 Recovered as well as the time that has elapsed since their initial COVID-19 positive test. Please review the policy in full for appropriate care information specific to each scenario.