March 10, 2020
The Centers for Disease Control and Prevention (CDC) has updated its guidance for protection of healthcare personnel (HCP) when obtaining specimens for COVID-19 testing. As part of the “Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings” ( https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html ), the new guidance states:
collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab)
from a possible COVID-19 patient, the following should occur:
- HCP in the room should wear an N-95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown.
- The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.
- Specimen collection should be performed in a normal examination room with the door closed.
- Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.
This new guidance may allow more healthcare professionals to collect specimens from suspected COVID-19 patients in the office setting and submit those to commercial reference laboratories for testing. As a reminder, testing for COVID-19 is also available through the Kentucky Department for Public Health at the state public health laboratory, but approval for testing by this route must first be obtained through the state health department. The Lexington-Fayette County Health Department can assist healthcare providers with decision-making and be a liaison with the state health department in the testing process for COVID-19.
In terms of who should be tested, the CDC’s guidance remains the same:
- Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.
All patients who are positive for COVID-19 should be reported without delay to state or local public health authorities. To contact the Lexington-Fayette County Health Department, clinicians may call our provider-only line: 859-335-7071.
Kraig E. Humbaugh, MD, MPH