COVID-19 and Acceptable COVID-19 Clearance Tests for VMC surgery/procedures

Why are we making this change? There are now many types of Covid-19 tests available and most are not currently approved as acceptable for asymptomatic surgery/procedural clearance purposes. Therefore, for safety of all physicians and staff caring for patients having aerosolizing-generating procedures (AGPs), please note the following:

1. Outside COVID-19 negative test will not be used for determination of preprocedural COVID status. Testing needs to be completed by Valley or by the usual pathways to LabCorp, public health or UW. *
2. An outside COVID-19 positive test can be used to determine preprocedural COVID status.

Elective procedures will be cancelled/rescheduled if the clearance test does not meet these parameters.

* In the rare instance, an urgent surgery needs to be performed and the designated COVID surgery suites are in use, if an outside COVID-19 test is available in the 72 hours window (not a rapid, antigen or antibody test), the surgeon, anesthesiologist and perioperative leader will use clinical judgement to collaboratively determine COVID status and subsequent precautions. Consider Lab Medicine or Infectious Disease consultation to understand lab result.

COVID-19 Retesting Guidelines for Inpatients Needing a Procedure/Surgery Involving Aerosolizing-Generating Procedures

• All inpatients are already tested on admission to hospital.
• All elective surgery patients tested within 72 hours of scheduled surgery.
• Change: If negative test > 72 hours old, a retest with result is required for any procedure/surgery requiring an AGP such as intubation.

Why are we making this change? There is increasing spread of COVID -19 throughout the community and VMC’s goal is to minimize risk of exposure to healthcare workers. To date, we have not been retesting inpatients after the initial “not detected” test on admission.

Protocol:

--When decision that surgery/procedure is needed, validate current negative test result is available within 72-hour window. If not, new test is needed.

--Ordering provider to enter COVID-19 Clearance test (LAB2590) order.

--Inpatient RN to obtain nasopharyngeal swab per protocol. When obtaining the NP swab, use standard/contact/droplet precautions: mask, eye protection, gown, and gloves. No need for COVID-19 isolation precautions as this is an asymptomatic patient.

--Standard Precautions (e.g. COVID-19 precautions not needed for screening asymptomatic patients).

--Patient can remain on their current unit.

-Surgery/procedure to take place once re-test result available unless classified as urgent /emergent by provider.