Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland.
Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland.
Clin Microbiol Infect. 2022 May;28(5):672-680. doi: 10.1016/j.cmi.2022.01.007. Epub 2022 Feb 3.
This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures.
A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach.
Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.
本指南针对医疗机构中无症状个体进行严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）直接检测的适应证，旨在预防这些环境中的 SARS-CoV-2 传播。对无症状个体进行检测以创造安全的患者和医护人员环境的益处，必须与潜在的意外后果相权衡，包括因假阳性结果而延迟必要的治疗以及因严格的隔离措施而导致的护理质量下降。
小组成员选择了九个关于无症状个体检测的 PICO（人群、干预、比较、结局）问题。随后，在 PubMed、Epistemonikos 和 RecMap 上使用每个数据库中可用的相关筛选器，对现有指南和系统评价进行了文献检索。提取了关于文章/建议类型、设置、目标人群、干预和证据质量的数据。使用 AMSTAR 工具评估系统评价的可信度，并使用 AGREE II 评分评估与现有建议的一致性程度。由于从系统评价中获得的证据被认为更新不足，无法制定相关建议，因此针对主要公共卫生机构的相关指导文件和原始研究进行了额外的搜索。通过网络会议讨论临时建议，直到达成一致意见，然后根据 GRADE 方法制定最终建议。
在医疗机构中，对无症状个体进行入院时、住院期间、择期手术前和非手术计划前的系统性检测，提出了建议。此外，还提出了关于在医疗机构中对无症状访客、个人护理人员和医护人员进行检测的建议。还就无症状患者或医护人员的接触者追踪和阴性筛查检测以缩短隔离期提出了建议。此外，如果适用，还对传播率和疫苗接种覆盖率进行了具体建议。
