The Welsh NHS is changing its rules on Covid testing for patients who need an admission to hospital. Following the rollout of the vaccine, which has been successful in reducing severe illness, hospitalisation and death, the decision has been made to alter the type and frequency of tests carried out by certain patients.
It is hoped the changes will boost the ability of staff to carry out routine and emergency care, as well as aid the flow of patients through hospital treatment and, for some, their discharge into social care. The testing alterations will affect pre-admission testing for planned procedures, admission for unscheduled care, post-admission testing for asymptomatic and symptomatic patients, and discharge testing arrangements.
Health Minister Eluned Morgan said: "The pandemic has not gone away and we are still learning to live with Covid-19, but the current public health situation allows us to make appropriate changes to the testing regime that supports health boards to implement the necessary infection prevention and control (IPC) strategies that will have a positive impact on routine and emergency care.
"We are making these changes based on the best scientific, public health and expert evidence available at this time, changes that enable local decisions to support the best possible patient care. Thanks to our incredible vaccination programme the risk to the NHS of being overwhelmed is now greatly reduced and we can make changes to the testing regime within the context of other infection prevention and control measures." Here is a quick rundown of the changes being put in place:
Pre-admission testing
The Welsh Government confirmed that testing ahead of an admission to hospital will remain, but the type of test will be based on a patient's individual risk from infection. It will see asymptomatic patients who are having a surgical procedure or chemotherapy tested using a PCR or point of care test (POCT) 72 hours before admission and asked to self-isolate until their procedure.
For some asymptomatic low-risk patients being admitted for low-risk procedures, health boards may decide a negative lateral flow device (LFD) on or just before admission may be sufficient.
Testing on unscheduled admission
This will also see changes. Patients with respiratory symptoms who need an unscheduled admission to hospital will be tested for a range of illnesses (Covid-19, Influenza, RSV as a minimum) on one PCR or POCT swab.
Patients without respiratory symptoms will be tested for Covid-19 only using a LFD on admission.
Testing once in hospital
In line with changes in the general public and in care settings, after patients are admitted no further routine asymptomatic testing is advised unless a local decision deems it necessary.
Symptomatic testing will continue, with patients who develop symptoms being tested with a PCR or POCT for Covid-19, influenza, RSV or a full multiplex (as many as 26 different conditions) as clinically directed.
Patients who have tested positive for Covid on or since admission can assume non-infectivity when:
- Symptoms have resolved, absence of a fever, plus
- 10 days have elapsed OR
- a locally decided testing protocol is used to reduce the isolation period down from 10 days in patients who meet the clinical criteria above. These tests can be LFD or other rapid antigen detection tests. Patients should have two negative tests taken 24 hours apart as well as showing clinical improvement as above, before being moved out of isolation and discharged.
Health boards will also be encouraged to work with care home providers on discharge testing arrangements. The Welsh Government said the changes to testing in hospital settings are being made now as during high community incidence of Covid-19 there has been a "relatively modest" impact on hospital admissions and deaths, whilst the extent of hospital-acquired Covid deaths has also significantly reduced.
The advice that all patient-facing healthcare staff should test using LFDs twice weekly is regularly reviewed and continues to be advised. To keep up to date with the latest coronavirus news from across Wales subscribe to our Covid Briefing newsletter here.
