Universal admission screening for COVID-19 using quantitative antigen testing and questionnaire screening to prevent nosocomial spread

Abstract

Background In this study, we investigated diagnostic accuracy of quantitative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen testing and whether universal screening was effective to prevent a nosocomial outbreak of coronavirus disease 2019 (COVID-19). Methods All adult patients admitted to an acute-care hospital in Tokyo, Japan, after receiving LUMIPULSE SARS-CoV-2 Ag using a nasopharyngeal swab and a brief questionnaire to evaluate symptoms and exposures from December 3, 2020 to March 20, 2021 were included. Results Of the 5191 patients, 53 were antigen-positive, 19 were inconclusive and 5119 were negative. The sensitivity and specificity (positive or inconclusive results) of the quantitative antigen test for COVID-19 diagnosis at admission was 0.957 (95% confidence interval [CI]: 0.855–0.995) and 0.995 (95% CI: 0.992–0.997), respectively. Six asymptomatic patients were identified on admission. Two patients were antigen-negative and diagnosed with COVID-19 later; however, they had been isolated prior to diagnosis because both had symptoms of COVID-19 and exposure. No nosocomial infections occurred during the period. Conclusion Quantitative SARS-CoV-2 antigen testing was found to be valid for the early detection of asymptomatic COVID-19 patients as a universal screening test on admission.

The Utility and Limitations of Universal Polymerase Chain Reaction Screening for SARS-CoV-2 During Hospital Admission

“…Ten of these cases (0.76% of total tests) were diagnosed as acute-phase COVID-19. Previous studies at other Japanese hospitals have reported 0.07% to 1.81% SARS-CoV-2 positivity for routine screening tests [ 6 - 8 ]. Our PCR positivity rate (0.76%) is thus similar to that of other Japanese studies conducted before the omicron variant outbreak.…”

“…Measures to prevent SARS-CoV-2 infection in hospitals include patient and staff screening, hand hygiene, isolation of patients with a suspected infection, and vaccination [ 5 ]. Among these measures, screening of patients on admission by polymerase chain reaction (PCR) [ 6 , 7 ] or antigen [ 8 , 9 ] tests has been found to be particularly effective. It can be difficult to diagnose COVID-19 on the basis of symptoms alone among individuals with other respiratory diseases, given the similarity in symptoms between these conditions.…”

Analyzing Breakthrough Infections in a Tertiary Care Hospital: A Retrospective Study Utilizing RAT-Based Screening

“…5 Data from previous research has shown the detection of SARS-CoV-2 with RAT compared to RT-PCR. 6,7 There are certain pitfalls in using RAT like most of the kits require nasopharyngeal swab which is quite difficult to collect in pediatric age group and in mentally challenged individuals, a meta analysis study shown an average sensitivity and specificity of RAT as 56.2% and 99.5% respectively. 8 There are various RAT kits approved by ICMR for the diagnostic use.…”