Screening asymptomatic healthcare workers for COVID-19 not recommended, experts say

Routine screening of asymptomatic healthcare personnel in the absence of confirmed exposures to the novel coronavirus (COVID-19) is not a recommended strategy for preventing transmission, according to a new review by researchers at Massachusetts General Hospital and published in the journal Infection Control & Hospital Epidemiology.

Such testing is unlikely to affect the transmission of SARS-CoV-2 in healthcare settings and could even have unintended negative consequences, according to co-authors Erica Shenoy, MD, PhD, associate chief of the Infection Control Unit at Massachusetts General Hospital and David Weber, MD, MPH, professor of medicine in the division of Infectious Disease at the University of North Carolina.

Many institutions require individuals in their organization to undergo routine testing for COVID-19, whether they are experiencing symptoms. Current public health recommendations are to test individuals with symptoms consistent with COVID-19 and those with confirmed exposures. At Massachusetts General Hospital and across the health system, asymptomatic employees are provided access to testing when it is required, such as for travel, but routine surveillance of healthcare personnel has not been pursued.

For the review, researchers compiled data from Massachusetts General Hospital’s voluntary testing program as well as several other hospitals that had either screened or made COVID-19 testing available to asymptomatic healthcare personnel. Infection rates ranged from 0.2 percent to 0.4 percent, which the researchers said is low.

Given the low frequency of positive tests, the possibility of false positive results is a concern, and the researchers describe how facilities considering routine surveillance must consider whether confirmatory testing would be used to address the possibility of false-positive results. Meanwhile, a negative test result should have no impact on a healthcare professional's day-to-day actions. Yet it's possible, the researchers said, that healthcare providers who test negative may change their behavior and relax their guard outside of the clinical setting, such as not wearing a face covering in hospital breakrooms or choosing to attend gatherings outside of work.

Studies suggest that the risk of healthcare personnel and patients transmitting the coronavirus to one another is very low when effective safety protocols such as wearing masks, testing when indicated, and screening symptomatic patients are followed. Reported instances of healthcare personnel acquiring infection through exposures to patients show overall low risk of transmission. Similarly, risk to patients from asymptomatic infected healthcare providers has also been reported to be low, highlighting the efficacy of current protocols, the researchers said.

Instead of considering routine screening of health care personnel for COVID-19, the researchers said hospitals should continue to focus on interventions that are known to reduce spread of the disease, which also include rapid identification and isolation of patients who are suspected of COVID-19, proper use of personal protective equipment when appropriate, and testing asymptomatic patients known to have been exposed to the coronavirus. 

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