Is Your Screening Strategy Sufficient?

Marta Kalas, Co-founder of COVID-19 screening soſtware developer Thomson Screening, discusses the main considerations you need to make when introducing a COVID-19 screening programme within your care facility.

Care homes have had a particularly challenging time over the last six months, with relatives desperate to see each other. The overriding risks of infection, for both staff and resident, however, have made this sort of contact near impossible.

No doubt you already have all the relevant PPE in place, plus information about how to control infection and clean areas. But how will you know when your risks increase and you need to take different steps? Will you be able to notice a new source of infection in good time? This is where regular and methodical testing can help.

When designing a testing programme, you need to ensure it meets an extensive set of criteria. Firstly, it must be well planned and documented. It also needs to be systematic. Even when doing random spot checks, you must make it clear who has been tested, when and how. As with the pre-screening measures, you need to be just as thorough with what you have in place for post screening. What specific actions will you take if certain results are found? Make sure to follow Public Health England (PHE) guidelines when devising the plan and, if possible, carry it out under clinical supervision.

There are also several pitfalls which the testing programme must avoid. Careful consideration is needed, so do not just improvise or introduce the latest test available without assessing the implications. The testing must not lead to discrimination or anything which could be perceived as discrimination. In keeping with Data Protection laws, data must be destroyed once it is no longer needed and the process of doing so must be documented. You must also ensure that the system you use is not at risk of security breaches. All tests must be approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Equally, you must refrain from interpreting results to one’s own purposes.

In addition, there are a number of questions you need to ask when creating a testing programme. What type of information will you be collecting and what action will you follow if you found it? For example, will it lead to more testing of a specific group? How will PPE use need to change? Will shiſt patterns or workflow need to change?

What other information will you need to record in order to give context to the testing? What type of test needs to be carried out in relation to any symptoms? Will tests need to be repeated and, if so, at what intervals? How will you manage repeated testing? How long is the information valid?

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There are also some common myths that need to be busted. Don’t wait for test results to decide whether someone should isolate- isolation should happen as soon as symptoms are detected. Also, previous infections do not always produce anti- bodies. For example, the entire Hungarian national swimming team tested positive for the virus. Later, they offered their plasma to help others in recovery. However, to everybody’s surprise, none of them produced any antibodies.

According to the World Health Organisation (WHO), the so called ‘Immunity Passports’ should not be encouraged as we simply do not know how long immunity lasts and it can create a false sense of security.

You will also need to talk to your team about a) the reporting procedure if a member of staff or a resident is found to have COVID-19; b) how testing will change or increase if a resident or relative reports that they have COVID-19, and c) what actions will be taken if a test is positive. These elements need to be considered and decided in advance of the testing programme commencing.

Finally, make sure that your testing programme does not conflict with UK employment law. This is a grey area at the moment since as an employer you have a duty of care, but how would you carry out that duty without good information? Again, specific advice, both on the legal and clinical aspects of a testing programme, as well as clear and transparent action plans, are the best way forward.

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