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Evaluating pooled testing for asymptomatic screening of healthcare workers in hospitals.

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Heath, Bethany 
Evans, Stephanie 
Robertson, David S 
Robotham, Julie V 
Villar, Sofía S 

Abstract

BACKGROUND: There is evidence that during the COVID pandemic, a number of patient and HCW infections were nosocomial. Various measures were put in place to try to reduce these infections including developing asymptomatic PCR (polymerase chain reaction) testing schemes for healthcare workers. Regularly testing all healthcare workers requires many tests while reducing this number by only testing some healthcare workers can result in undetected cases. An efficient way to test as many individuals as possible with a limited testing capacity is to consider pooling multiple samples to be analysed with a single test (known as pooled testing). METHODS: Two different pooled testing schemes for the asymptomatic testing are evaluated using an individual-based model representing the transmission of SARS-CoV-2 in a 'typical' English hospital. We adapt the modelling to reflect two scenarios: a) a retrospective look at earlier SARS-CoV-2 variants under lockdown or social restrictions, and b) transitioning back to 'normal life' without lockdown and with the omicron variant. The two pooled testing schemes analysed differ in the population that is eligible for testing. In the 'ward' testing scheme only healthcare workers who work on a single ward are eligible and in the 'full' testing scheme all healthcare workers are eligible including those that move across wards. Both pooled schemes are compared against the baseline scheme which tests only symptomatic healthcare workers. RESULTS: Including a pooled asymptomatic testing scheme is found to have a modest (albeit statistically significant) effect, reducing the total number of nosocomial healthcare worker infections by about 2[Formula: see text] in both the lockdown and non-lockdown setting. However, this reduction must be balanced with the increase in cost and healthcare worker isolations. Both ward and full testing reduce HCW infections similarly but the cost for ward testing is much less. We also consider the use of lateral flow devices (LFDs) for follow-up testing. Considering LFDs reduces cost and time but LFDs have a different error profile to PCR tests. CONCLUSIONS: Whether a PCR-only or PCR and LFD ward testing scheme is chosen depends on the metrics of most interest to policy makers, the virus prevalence and whether there is a lockdown.

Description

Acknowledgements: The authors would like to acknowledge Tom Fowler for his useful insights and expertise on the practicalities of a pooled testing scheme. The authors would also like to acknowledge Angela Douglas and Andrew Beggs for their helpful insights on the dilution effects of pooled testing.

Keywords

Nosocomial transmission, Pandemic preparedness, Simulation study, Testing policy, Humans, COVID-19, Retrospective Studies, Hospitals, Health Personnel, Cross Infection

Journal Title

BMC Infect Dis

Conference Name

Journal ISSN

1471-2334
1471-2334

Volume Title

23

Publisher

Springer Science and Business Media LLC
Sponsorship
MRC (Unknown)