5.9 Respiratory testing for service users

5.9.1 COVID-19 Testing

5.9.2 Testing for other respiratory pathogens

In order to ensure prompt safe placement and treatment of service users with respiratory symptoms, testing will help to inform the clinical/care team of the causative pathogen.  This will help to avoid placing multiple service users with different respiratory pathogens in the same room for extended periods of time risking transmission of multiple pathogens between service users. Testing for other respiratory pathogens beyond SARS-CoV-2 may not be routinely necessary in all settings such as residential care areas and care homes.

5.9.1 COVID-19 testing 

To ensure patients are placed appropriately within health and care settings, COVID-19 testing is required.

Rapid Diagnostic Tests (including POCT) or LFD tests may now be used in some health and care settings (see sector specific content below) to help determine any requirements for transmission based precautions and to support IPC risk assessments including patient placement, patient transfers, management of contactsin inpatient settings and outbreak management. 

The use of rapid diagnostic tests (including POCT) or LFD described throughout this guidance is an option available to NHS Boards where they can be operationalised at a local level and have the ability to ease service pressures and patient flow. (Refer to section 5.2 Organisational preparedness)

COVID-19 test results should not be used as a standalone tool for risk assessment but in conjunction with symptom and clinical assessment.

Anyone who has previously tested positive for SARS-CoV-2 by PCR should be exempt from being re-tested using PCR within a period of 90 days from their initial symptom onset, or the first positive test, if asymptomatic, unless they develop new possible COVID-19 symptoms. This is because fragments of inactive virus can be persistently detected by PCR in respiratory tract samples for up to 90 days following infection.

If an asymptomatic person is inadvertently re-tested and tests positive by LFD or PCR within 90 days of a previous positive test result, a risk assessment will likely conclude there is no need to do a confirmatory PCR, isolate or contact trace again, as long as the person with the repeat positive test:

See section 5.15.7 for determining the precautions required for AGPs and the associated testing.

 

Primary Care and Community Health and Social Care settings

If an individual has COVID-19 symptoms they should visit the NHS inform website for advice on testing and self isolation.

GPs who have arranged a face to face consultation with an individual who has symptoms of COVID-19 should proceed following the respiratory pathway and following treatment should advise that they visit NHS Inform for advise on testing if they have not already done so.

 

Dental settings - COVID-19 testing

Dental teams who have arranged a face to face consultation with a patient which cannot be postponed and who has symptoms of COVID-19 should proceed following the respiratory pathway and following treatment advise that the visit NHS Inform for advice on testing and self-isolation if they have not already done so.

 

Secondary care Settings 

Testing requirements within secondary care are as follows:

A table containing a summary of testing requirements in NHS Scotland is available.  When using this table the following applies;

 

Care home settings

Guidance on COVID-19 testing in care home settings can be found in the PHS COVID-19: Information and Guidance for Care Homes (Adults and Older People)

 

5.9.2 Testing for other respiratory pathogens

It may be necessary to test for other respiratory pathogens including COVID-19 to support service user placement but also ensure optimal treatment provision.

GPs may choose to perform a respiratory screen on an individual if clinical assessment indicates this is necessary.  If so, they should continue to do so via routine processes. There is no expectation to perform respiratory testing in primary care, or dentistry beyond routine processes indicated by clinical assessment.

Secondary Care settings

On arrival at a secondary care facility, all patients should have COVID-19 testing undertaken as per 5.9.1. Clinical teams may choose to perform a full respiratory screen if clinical assessment indicates this is necessary to support diagnosis.

Care Home Settings 

Residents who test negative for COVID-19 but who have ongoing respiratory symptoms do not routinely require any additional testing.  However, should a resident require a consultation with a GP, the GP may choose to perform a full respiratory screen if a clinical assessment indicates this is necessary. Or if there is considered to be a cluster of cases and these are COVID-19 negative then additional testing by multiplex PCR can be performed to identify the pathogen.

Where respiratory screens are performed and the service user tests positive for COVID-19 within 90 days of previous positive test, this will require careful consideration and interpretation by clinicians with microbiology support where required.