Introduction Infection prevention strategies to protect health care workers in the endoscopy unit during the post-peak phase of the COVID-19 pandemic are currently under intense discussion. In this paper, the cost-effectiveness of routine pre-endoscopy testing and high-risk personal protective equipment (PPE) is addressed. Methods A model based on theoretical assumptions of 10,000 asymptomatic patients presenting to a high-volume center was created. Incremental Cost Effectiveness Ratios (ICER) and absolute costs per endoscopy was calculated using a Monte Carlo simulation. Results ICER values for universal testing decreased with increasing prevalence rates. For higher prevalence rates (≥1%), ICER values were lowest for routine pre-endoscopy testing coupled with use of high-risk PPE while cost per endoscopy was lowest for routine use of high-risk PPE without universal testing. Conclusion In general, routine pre-endoscopy testing combined with high-risk PPE becomes more cost-effective with rising prevalence rates of COVID-19.

Objectives The gold standard for diagnosing an infection with SARS-CoV-2 is detection of viral RNA by nucleic acid amplification techniques. Test capacities, however, are limited. Therefore, numerous easy-to-use rapid antigen tests based on lateral flow technology have been developed. Manufacturer-reported performance data seem convincing, but real-world data are missing. Methods We retrospectively analysed all prospectively collected antigen tests results performed between 23.06.2020 and 26.11.2020, generated by non-laboratory personnel at the point-of-care from oro- or nasopharyngeal swab samples at the University Hospital Augsburg and compared them to concomitantly (within 24 h.) generated results from molecular tests. Results For a total of 3630 antigen tests, 3110 NAAT results were available. Overall, sensitivity, specificity, NPV and PPV of antigen testing were 59.4%, 99.0%, 98.7% and 64.8%, respectively. Sensitivity and PPV were lower in asymptomatic patients (47.6% and 44.4%, respectively) and only slightly higher in patients with clinical symptoms (66.7% and 85.0%, respectively). Some samples with very low Ct-values (minimum Ct 13) were not detected by antigen testing. 31 false positive results occurred. ROC curve analysis showed that reducing the COI cut-off from 1, as suggested by the manufacturer, to 0.9 is optimal, albeit with an AUC of only 0.66. Conclusion In real life, performance of lateral-flow-based antigen tests are well below the manufacturer's specifications, irrespective of patient’s symptoms. Their use for detection of individual patients infected with SARS-CoV2 should be discouraged. This does not preclude their usefulness in large-scale screening programs to reduce transmission events on a population-wide scale.

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The Corona pandemic and the associated need for visitor restrictions have defined an entirely new management task in hospitals: The hospital visitor management. The admission process of hospital visitors and the implementation of associated infection-prevention strategies such as the delivery of face masks thereby pose major challenges. In this work, we evaluate both implemented and planned admission processes in a German University Hospital based on a discrete-event simulation model and provide distinct recommendations for hospital visitor management with special consideration of digitalization, antigen testing, waiting times, space and staff utilization. We find the extraordinary potential of digitalization with a reduction of visitor waiting and service times of up to 90 percent, the significant burden for personnel and room capacity, in terms of antigen testing, especially, and the need for visitor restrictions in terms of a maximum number of visitors per inpatient.