NHS Grampian SARS-CoV-2 / COVID-19 Testing Policy

NHS Inform Provides quality assured information and self-help guidance for peopleabout Covid-19 in general and about getting tested.NHS National Services Scotland (NSS) hold a secure data store for results ofPCR/lateral flow test (staff) and transfer data on positive results to the CaseManagement System (NSS) for purpose of contract tracing.Occupational health provide organisational and staff support in relation to stafftesting resultsPatients* and staff who consent to testing cooperate with testing procedures andare asked to act on advice and guidance provided with test results and in accordancewith NHS Grampian’s clinical and organisational policies (*where capacity exists).Procurement develop and maintain ordering and supply systemsPublic health analyse, interpret and report aggregate testing data; follow up allpositive test results, manage outbreaks.Public Health Scotland publish national clinical and public health guidance. Publichealth Scotland also runs the Enhanced Surveillance of COVID-19 programme inScotland.4Test and Protect (national and local) follows up on of cases confirmed by a positivePCR test in order to contact trace individuals who may have been infected as a closecontact of the positive case, and supports them to self-isolate2. They also follow upon positive LFD tests too before the individual gets a confirmatory PCR.Virology laboratory assure testing of samples and reporting capacities andcapabilities.8. Detailed Procedures8.1 Symptomatic testingTesting of individuals with symptoms should be the priority to reduce transmissionthrough contact tracing and self-isolation as well as provision of clinical care, whenrequired.People who have had a positive PCR test should be excluded from anyasymptomatic testing, for example occupational or community testing initiatives, for90 days following the initial positive result. 5 The exceptions to this are Anyone who develops new symptoms of COVID-19 at any point following a positivetest should undertake a further test;45HPS Website - Components of the programme (scot.nhs.uk)COVID-19 Guidance for Secondary Care Settings (windows.net)NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 4

‘Clinical testing’ refers to the testing to an individual symptomatic person, as partof their receipt of healthcare, by an authorised medical clinician. This would includeall care home residents who develop symptoms of COVID-19.6Clinicians should test all patients who meet any of the case definition criteriadescribed in section 4 (above). Clinicians should be alert to the possibility ofatypical and non-specific presentations in older people with frailty, those with preexisting conditions and patients who are immunocompromised. Inpatients must beassessed for bacterial sepsis or other causes of symptoms as appropriate.5,7Patients who develop symptoms following admission to a healthcare or social caresetting should continue to be tested immediately.Results should be followed up by the responsible clinician on the current laboratoryreporting systems. A positive lab result will automatically populate TrakCare.‘Staff testing’ refers to testing members of health and social care staff, and theirhousehold members, who are symptomatic to detect infection early and isolatethem to reduce the risk of transmission to high risk individuals and in high riskenvironments. Testing of staff and household members also informs the lifting ofhousehold isolation and the timing of the staff member’s return to work.Staff should isolate (along with their household members) and be tested if theymeet any of the classic or wider symptoms of COVID-19 described in section 4(above). Household members should be tested if they have any of the three classicCOVID-19 symptoms listed in section 4.All health and social care staff must be tested at the NHS Grampian staff testingservice.8 Eligible staff include everyone employed by NHS Grampian and staff inthe three health and social care partnerships, NHS24, NHS National Services forScotland, Scottish Ambulance Service, primary care staff including general medicalpractice, general dental practice, pharmacy and optometry; any social careprovider, all and any care home, and any unpaid carer or NHS or social carevolunteers.NHS Grampian will provide access to booking appointments for ‘staff testing’ at oneof the facilities across Grampian through a single webpage which will includerelevant information and a single route for self-referral at Covid 19 Staff TestingRequest.Drive through ‘staff testing’ facilities are available in Aberdeen, Elgin and Huntly.NHS Grampian also provides a limited number of community tests which are carriedout at the person’s home if a member of staff or their household who is eligible to betested is unable to drive to one of the drive through facilities.6Coronavirus (COVID-19): adult care home visitor testing guidance - gov.scot /8Staff COVID-19 Testing (nhsgrampian.org)7NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 5

8.2Asymptomatic testing‘Asymptomatic testing’ refers to testing of individuals with no signs of illness to protectthem, patients, colleagues and household members by increasing isolation of infective,asymptomatic individuals. It will be used to reduce harm to individuals at high risk oftransmission of the virus from unidentified cases in high risk environments. 9Asymptomatic testing is carried out using PCR and/or lateral flow antigen tests dependingon the strategy for asymptomatic testing, innovations and capacity.Asymptomatic testing is available for patients (see appendix 1), healthcare staff (appendix2) health and care students undertaking clinical placements, care home residents(appendix 3), care home staff (appendix 4), visitors to care homes (appendix 5),designated and essential visitors to care homes (appendix 6) and staff providing care athome services, sheltered housing or housing with multiple occupancy, day care andpersonal assistants (appendix 7).Staff who have had a positive result with their lateral flow antigen test (see appendix 2 & 4)must attend for PCR testing at an NGS Grampian testing site and be told to self-isolateuntil they receive the result of their PCR test.9. Public health testing/outbreak management‘Public health testing’ refers to group testing undertaken to inform cluster and outbreakmanagement, or population testing taken for epidemiological or contact tracing purposes.9.1Clusters and outbreaksNHS Grampian’s Health Protection Team (HPT) will investigate and manage clusters andoutbreaks of COVID-19 in closed settings (e.g. care homes, sheltered housing complexes,prisons) and in healthcare settings with the Infection Prevention and Control Team (IPCT).If an outbreak is declared in a care home, particular attention will be given to wider testing,including all residents and staff, irrespective of the presence of symptoms. Any care homethat has employed or agency staff links with another facility where an outbreak has beendeclared, must also be assessed for wider testing as part of the heath protection response.9.2Contact tracingNHS Grampian will cooperate with sampling and/or testing requirements associated withnational contact tracing programmes as these are developed and implemented.9.3Epidemiological testingNHS Grampian will cooperate with national epidemiological sampling and/or testingprogrammes and/or genome sequencing programmes as these are developed andimplemented.10Review and revisionsThis policy will be reviewed every three months and updated as the COVID testinglandscape evolves.9Clinical and scientific review of testing - gov.scot (www.gov.scot)NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 6

AppendicesAppendix 1 - Asymptomatic testing – patients in health care settings (PCRtesting)10All patients with a planned (including planned medical or elective surgical)admission to hospital are required to have their test undertaken prior to admissionby trained staff or at a NHS Grampian test centre. The test should be taken 48 to72hr before to their admission.11 The patient should have a ‘negative’ test resultbefore admission to hospital.The test is arranged through NHS Grampian’s booking team for testing and istaken at one of NHS Grampian’s staff testing facilities. A limited number ofcommunity tests which are available to be carried out at the person’s home ifunable to drive to one of the drive through facilities.All emergency and unplanned admissions to hospital are required to be tested onadmission (i.e. acute, DGH, MH&LD, AMH, RACH, community hospitals).Results should be followed up by the responsible clinician on the currentlaboratory reporting systems. A positive lab result will automatically populateTrakCare.All patients who a ‘negative’ test result on admission to hospital should be retestedon day 5 of their in-patient stay.12 This includes non-Covid patients who are beingtransferred to another ward or another hospital or health board area. This lattergroup of patients must be tested on admission to the other hospital.Patients being discharged from hospital to a care home who have recovered fromCOVID-19 are required to have two ‘negative’ tests before discharge from hospital.The tests should be taken at least 24 hours apart and in the 48 hours beforedischarge from hospital.Patients being discharged from hospital to a care home who have not had Covid19 should be tested preferably 48hours prior to discharge with a single ‘negative’result before discharge.Appendix 2: Asymptomatic testing – health care workersRoutine twice weekly testing with Lateral Flow Antigen Devices (LFD) will beoffered to all healthcare workers in patient facing roles within hospitals, theScottish Ambulance Service, Community (COVID-19) Assessment Centres. It alsoincludes district nurses, community nurses, GPs and practice nurses.13 This formof testing includes, but is not limited to, all clinical students on placement, porters,cleaners, maintenance staff, volunteers, chaplains, healthcare scientists, alliedhealth professionals (AHPs), doctors, nurses, bank/agency staff. 14 Staff will beable to test themselves in their home or workplace.10DG Health and Social Care (Acting).dot (scot.nhs.uk)NHSG Staff Protocol CRA Screening Management Patients conf susp COVID-19 (SARS-COV2) v2 Dec2020.pdf(scot.nhs.uk) acutesettings/#a275313Grampian Covid-19 brief, 18.01.21 i.e. DN’s, community nurses, GPs and practice .pdf11NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 7

NHS Grampian will provide access to information, mandatory training and orderforms for health care workers taking part in twice weekly asymptomatic testingusing rapid lateral flow antigen test devices (LFD) at Healthcare staff LFD testing.Results from LFD tests must be fed into national data surveillance systems andseparately to PCR test reporting. Staff must log their LFD test results on the NHSScotland Covid Testing and Registration Portal at COVID 19 Testing Portal.Staff in high-risk clinical settings such as oncology and haemato-oncology and inwards and day patient areas, including radiotherapy; elderly care and mental healthwards with stays over 3 months12 who are participating in weekly PCR testing orwho are participating in studies such as SIREN, should continue their currentmethod of PCR testing in line with local guidance and/or study protocols. Thesemembers of staff should be offered the opportunity to access weekly LFD testing inaddition to their PCR test.Appendix 3 - Asymptomatic testing – residents in care homes (adults andolder people) - PCR testingAsymptomatic individuals being admitted to a care home from the communityrequire at least one test to be performed before or on admission to the care home,with consent. PCR testing of residents for transfer purposes only provides partialreassurance. Infection may still develop subsequently at any time during theincubation period.15Residents being admitted to a care home from hospital who have not had COVID19 should be tested, with consent, preferably 48hours prior to discharge with asingle ‘negative’ result before their discharge.Residents being discharged to a care home from hospital who have recovered fromCOVID-19 should have two ‘negative’ tests before discharge from hospital. Testsshould be taken at least 24 hours apart and preferably within 48 hours of discharge.Where testing is not possible (e.g. resident doesn’t consent or it would causedistress) a risk assessment and an agreed care plan for the remaining period ofisolation up to 14 days in the home must be agreed. 13PCR testing of residents in care homes for surveillance of COVID-19 is carried outon a rota of every 10 weeks for each care home in Grampian. This is organised byNHS Grampian’s testing team. Training videos for staff taking resident’s swabs areavailable at https://vimeo.com/409481946.Appendix 4 - Asymptomatic testing – staff in care homes (adults and olderpeople)13All care home staff are offered and should have access to twice weekly LFD tests tobe used alongside the weekly PCR test as part of enhanced testing of staff in carehomes and in line with the SAGE recommendations.16 The first LFD test should becarried out on the same day as the PCR test. Approved guidance and training fortwice weekly LFD testing in care homes is available from COVID-19: adult carehome visitor testing guidance.15COVID-19: Information and Guidance for Care Home Settings (Adults and Older People) es/documents/coronavirus/231220 Letter to Care Homes Enhanced Staff Testing -.pdf16NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 8

Weekly PCR testing will be organised by the care home manager and undertaken inthe care home on specified days of the week. PCR samples will be will be analysedby the regional laboratory hub based in Aberdeen.Results from LFD tests must be fed into national data surveillance systems andseparately to PCR test reporting. Staff must log their LFD test results on the NHSScotland Covid Testing and Registration Portal at COVID 19 Testing PortalStock for twice weekly staff testing will be automatically issued to care homes every4 weeks until the national Covid ‘Testing and Registration’ portal is ready for carehomes to order from.Appendix 5 - Asymptomatic testing – professional visitors to care homes (adultsand older people) 14,17Health care staff, such as district and community nurses and allied healthprofessionals employed by the NHS, and professionals from social care, socialwork, other non-NHS allied health professionals, and care inspectors who arevisiting care homes must undertake twice weekly LFD testing. This will be arrangedthrough their employer.14NHS professional visitors will carry out LFD testing in line with existing guidance,training and supply for health care workers, delivered by the NHS. National trainingand information materials are available at: Turas: IP&C learning and TURAS:Stepsfortakingswabs NHS Grampian training and information materials for twiceweekly LFD testing is available at Healthcare staff LFD testing.Professional visitors from the Care Inspectorate will have LFD tests delivered tothem from the Care Inspectorate headquarters which have been approved by theMHRA for use in adult care home settings.Distribution of LFD tests for social care professional visitors will be coordinated inthe HSCP’s.Professional visitors from Care Inspectorate and social care should complete theonline resources which includes training and competency materials before theybegin testing. The resources can be accessed at: COVID-19: adult care homevisitor testing guidance and TURAS: Stepsfortakingswabs15Appendix 6 - Asymptomatic testing – designated and essential visitors to carehomes (adults and older people)LFD tests for designated family or friends and routine (or non-urgent) visits fromspiritual and faith representatives to a care home can be offered. Protocols for suchvisits should be reviewed regularly in light of national restrictions for Covid-19 andeach local authority’s level of restriction. Testing of visitors with LFD tests must bedone along with required IP&C measures for the care home. If a visitor testspositive with a LFD test then they must be asked to leave the care home andadvised to seek a PCR test and self-isolate at home in accordance with nationalguidance.17Coronavirus (COVID-19): adult care home testing guidance for visiting professionals - gov.scot (www.gov.scot)NHS Grampian SARS-CoV-2/COVID-19 Testing PolicyVersion 2Page 9

Essential visitors who need to see a relative urgently do not need to be tested unlessthe individual wishes to be tested. Essential visits will be carried out using requiredIP&C measures for the care home. 18A small number of visiting professionals, e.g. podiatrists, dentist, optometrists, maynot be covered by the testing routes described in 8.2.5. In these circumstances theycan be tested on arrival at the care home or residential setting as part of thedesignated and essential visitors testing route and results will be recorded in thesame way.15 One off visits by such visitors can be referred to be tested by NHSGrampian testing team.Appendix 7 - Asymptomatic testing – staff providing care at home services,sheltered housing or housing with multiple occupancy, day care andpersonal assistants (adults and older people)All staff who undertake two or more visits to a person’s own home andwhere a person’s home is within a residential setting, sheltered housingcomplex or housing with multiple occupancies and day centres will beroutine offered antigen testing, as follows. In each instance if a staffmember has a positive result from their twice weekly LFD test they shouldhave PCR.19,20National information, guidance and training materials is available at SG:COVID-19: adult care at home testing and Test and Protect (www.gov.scot).Care at home staff - offered or have access to a weekly PCR test or twiceweekly LFD.Arrangeme

There are a number of tests available for SARS-CoV-2, which fit into the following two broad groups.3These testing groups are under constant review and subject to change in . 3 *COVID-19 Laboratory testing Frequently Asked Questions (windows.net) NHS Grampian SARS-CoV-2/COVID-19 Testing Policy