COVID-19 Patient Testing Guidance

Testing has been an important component of our COVID-19 response, and as our understanding of this virus has evolved, we have adjusted our diagnostic testing guidance accordingly. As more Marylanders get the COVID-19 vaccine, UMMS has implemented the UMMS Tiered Approach to Infection Prevention Practice and Presence at the Workplace (UMMS Tiered Approach) to guide all IP-related policies and guidance. The UMMS Tiered Approach provides the necessary flexibility to respond appropriately to current risk conditions while maintaining our System-based response to the COVID-19 pandemic.

When the UMMS Tiered Approach indicates that SARS-CoV-2 testing is required or recommended for patients or team members, providers should follow the guidelines and procedures outlined in the COVID-19 Testing Guidance.

This guidance was updated on February 28, 2023, to reflect the following:

Routine Pre-Procedure Testing:

• In alignment with professional society guidelines, UMMS is discontinuing routine pre-procedure testing for all asymptomatic patients. This means patients with procedures on or after February 28 will no longer need to be routinely tested for COVID-19.
• Optional pre-procedure SARS-CoV-2 testing may be ordered at provider discretion, based on cardiopulmonary risk or other medical reason where a delay in procedure due to COVID-19 infection would be appropriate.
• All patients should continue to be screened for COVID-19 symptoms or exposure and tested if indicated.

Admission Testing:

• UMMS will maintain admission testing for patients in shared spaces, including for patients being admitted to semi-private rooms and congregate care settings (e.g., behavioral health units).
• As is current practice, test results will not be necessary prior to patient placement.
• Admission testing will no longer be done using PCR testing and will instead use an antigen testing strategy. Utilization of antigen testing will allow us to better identify active infections and reduce unnecessary isolation or delays in care.
• For asymptomatic patients being tested using antigen tests, two consecutive tests are required, 24 to 48 hours apart. The updated Epic order for asymptomatic COVID-19 testing will be available on February 28.
• All symptomatic patients should be tested using multiplex combination RT-PCR test that includes testing for SARS-CoV-2 and other respiratory viruses

Click here to view the COVID-19 Testing Guidance.

FAQs

Why is UMMS discontinuing routine pre-procedure testing for asymptomatic patients?

At this stage in the COVID-19 pandemic, the potential risks of routine pre-procedure testing outweigh benefits. There is little evidence that routine pre-procedure testing is an effective method of reducing the spread of COVID-19. This approach may lead to unnecessary patient isolation and delays in care. All patients should continue to be screened for symptoms and exposure and tested if indicated. Pre-procedure testing will remain optional, at provider discretion, based on cardiopulmonary risk or other medical reason where a delay in procedure would be appropriate for a patients found to have COVID-19 infection.

When should I test a patient who is being admitted for care?

UMMS will maintain limited admission testing for patients being placed in semi-private rooms, congregate care settings such as behavioral health units, and inpatient locations with shared ventilation. Test results are not necessary prior to patient placement except in behavioral health units, where a single negative test in 48 hours prior to admission is required.

Why is UMMS moving to an antigen testing strategy for asymptomatic patient testing at admission?

Utilization of antigen testing will allow us to better identify patients with active infections as compared to PCR testing, which can be positive for weeks even in the absence of active infection, and reduce unnecessary isolation or delays in care.

Which patients are eligible for antigen testing?

Antigen testing should be used for testing asymptomatic patients who are eligible for admission testing for SARS-CoV-2 (i.e., behavioral health units and shared inpatient rooms). In addition, antigen testing can be used to determine whether isolation precautions can be discontinued earlier than using a time-based strategy (see Duration of Transmission-Based Precautions for Patients Suspected or Confirmed to Have COVID-19).

When using antigen testing, two consecutive tests are always required; this is included in the test order by default. The second test should be done 24-48 hours after the first test (if the first test is positive, then the second test can be canceled).

Testing for symptomatic patients, known COVID-19 exposure in the previous 10 days, and any optional pre-procedural testing ordered at provider discretion will continue to be done using the PCR platform and should not be done using antigen tests. Children younger than 2 years of age are not eligible for POC antigen tests and should be tested using PCR for all indications (note that lab-based antigen tests at UMMC Downtown Campus can only be used on patients of all ages including for children younger than 2 years).

What is the UMMS approach to testing patients presenting with symptoms of acute respiratory or flu-like illness, or COVID-19 symptoms?

For the majority of symptomatic patients (adult and pediatric), utilizing a SARS-CoV-2, influenza A/B and RSV combination RT-PCR test is recommended and is adequate in identifying the most commonly circulating respiratory viruses when identification of the specific virus is necessary to guide medical management. In most cases, use of a broader multiplex respiratory panel is not necessary for detecting the underlying cause of the patient’s symptoms.

When is it appropriate to order the broader respiratory virus panel?

Providers should order the broader multiplex respiratory panel for all symptomatic immunocompromised patients (adult and pediatric). Additionally, providers can use their discretion, in consultation with Infectious Diseases as needed, to order the broader panel for patients whose initial RT-PCR test is negative, when respiratory infection is suspected and when a diagnosis would influence care management (e.g., patients with respiratory failure of unknown underlying cause).

What is the appropriate swab for specimen collection?

Nasal swabs may be utilized for specimen collection for all symptomatic and asymptomatic patients and UMMS team members except when requesting the multiplex respiratory virus and bacterial panel for which an NP swab is required.

Are we retesting COVID-19 confirmed patients?

Please see the Duration of Transmission-Based Precautions for Patients Suspected or Confirmed to Have COVID-19 for detailed guidance, including when to use a symptom and time-based strategy or a test-based strategy for determining when a patient is COVID-19 recovered.