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Implementation of Pre-Admission Caregiver Testing for COVID-19
Michael He1, David R Peaper2, Thomas Murray1,2
1Department of Pediatrics.
Insights
Testing caregivers for coronavirus disease 2019 (COVID-19) before pediatric admissions improved hospital bed capacity by enabling patient cohorting. This strategy identified positive caregivers, preventing potential transmission and enhancing infection control measures.
Area of Science:
- Pediatric Hospital Medicine
- Infectious Diseases
- Public Health
Background:
- Caregivers present a risk for transmitting coronavirus disease 2019 (COVID-19) to hospitalized children.
- Implementing routine COVID-19 testing for caregivers before pediatric admissions is crucial for infection control.
Purpose of the Study:
- To describe the implementation of a caregiver COVID-19 testing pathway.
- To evaluate the impact of caregiver testing on patient cohorting and hospital bed capacity.
Main Methods:
- A testing pathway for caregivers of pediatric patients admitted to inpatient units was established in August 2021.
- Caregiver test results were utilized for cohorting, infection prevention, and bed management.
Main Results:
- 3.2% of 2558 tested caregivers were positive for COVID-19, with a surge during the Omicron variant wave.
- Testing identified 36 positive caregivers with negative children, necessitating isolation precautions.
- Patient cohorting, enabled by caregiver testing, increased hospital bed capacity from 74% to 100%.
Conclusions:
- Caregiver COVID-19 testing incidence mirrors community rates.
- Testing enhances bed capacity and identifies transmission risks missed by patient testing alone.
- Further research is needed to quantify the mitigation of nosocomial severe acute respiratory syndrome coronavirus 2 transmission through routine caregiver testing.
Background:
Caregivers are often at the bedside of hospitalized children posing an additional risk for coronavirus disease 2019 (COVID-19) transmission. We describe the implementation of caregiver COVID-19 testing before inpatient pediatric admissions and the effect on patient cohorting and bed capacity.
Methods:
We implemented an ordering pathway to facilitate COVID-19 testing of caregivers of patients admitted to the inpatient units from the pediatric emergency department, elective procedural admissions, or direct admissions at a tertiary children's hospital in the Northeastern United States in August 2021. Testing was expedited by the clinical laboratory, and caregiver results were used to inform cohorting, infection prevention, and bed management decisions.
Results:
From August 2021 to January 2022, 2558 caregiver tests were ordered through this pathway, and 83 (3.2%) were positive. Of the positive tests, 72 (86.7%) occurred after December 18, 2021, coinciding with the local Omicron variant wave. Among positives, 67 caregiver or child pairs were identified, and 36 positive caregivers had a COVID-19 negative child leading to use of isolation precautions. Reintroduction of patient cohorting increased overall bed capacity from 74% to 100% of available beds.
Conclusions:
The overall incidence of COVID-19 among caregivers before admission correlated well with rates of COVID-19 positivity among asymptomatic adults in the community during the study period. Implementation of caregiver testing increased bed capacity by reintroducing cohorting of patients and identified patients needing isolation that would have been missed by patient testing alone. More research is necessary to determine the extent that routine caregiver testing mitigates the risk of nosocomial severe acute respiratory syndrome coronavirus 2 transmission.
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