ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the healthcare setting

Scope: This guideline addresses the indications for direct testing of SARS-CoV-2 in asymptomatic individuals in healthcare 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 healthcare workers must be weighed against potential unintended consequences including delaying necessary treatments due to false positive results and lower quality of care due to strict isolation measures. Methods: A total of 9 PICOs 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 about article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews were 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 was formulated according to the GRADE approach. Questions addressed by the guideline and recommendations: Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a healthcare setting, during hospital stay, prior to elective procedures, and prior to scheduled non-surgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers and healthcare workers in healthcare facilities were presented. Also, recommendations were given on contact tracing in asymptomatic patients or healthcare 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.