Routine testing of staff now will be based on the level of COVID-19 activity in the community. That’s according to official new guidance released Wednesday in response to federal regulatory changes disclosed Tuesday.

Per the guidance, routine testing of staff correlates with the positivity rate in the county over the past week. If it is below 5%, staff should be tested once a month. If the positivity rate is between 5% and 10%, staff should be tested once a week. And if the positivity rate is over 10%, staff should be tested twice a week, according to the guidance. 

Beginning Friday, a website will provide county-level positivity rates. (See the section on the website titled “COVID-19 Testing,” according to the guidance.) 

 Because of the importance placed on the level of COVID-19 in the community, “facility staff, likely the infection preventionist, should be monitoring this website so he or she will know the frequency for routine testing,” Amy Stewart, MSN, RN, vice president of education and certification strategy for the American Association of Post-Acute Nursing, told McKnight’s.

Nursing homes also will be required to test staff and residents if any have symptoms of COVID-19 and if there are any new cases in the facility, according to the guidance. It does not recommend routine testing of residents unless they leave the facility routinely.

Access to testing key

The guidance highlights the importance of point-of-care testing devices or access to a laboratory that can ensure quick turnaround times for testing, Stewart noted.

“Facility leaders need to ensure they are using a POC testing device and that they have sufficient testing supplies in the event that there is a community outbreak and the testing frequency increases greatly,” she said. “If they do not have a POC testing device, they should have a laboratory that they work with who can ensure a 48-hour turnaround time for test results.”

Providers must note their efforts to obtain testing in the event that immediate action is not possible due to slow lab turnaround times or other factors, she noted.

“Document that the ‘XYZ laboratory indicated they could have COVID testing results within 48 hours but for seven out of 99 residents tested, the results took five days,’” she said as a hypothetical example.

Retesting rates, peer pressure

The guidance offers prescriptive testing measures in the event there is a new COVID-19 case. Upon discovery of a new case of COVID-19 in any staff or resident, “all staff and residents should be tested, and all staff and residents that tested negative should be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.”

Stewart said the new guidance makes it critical that staff come forward if they have symptoms.

“Some staff may ignore or downplay potential symptoms, so it is really important that staff and residents feel safe to come forward with symptoms and those symptoms are taken seriously every time,” she said. “This helps ensure that COVID doesn’t enter or spread in your facility.”

The guidance also updates the COVID-19 Focused Survey for Nursing Homes.

“Facility staff should review the changes made to this form because this is what surveyors will be using to ensure facility compliance,” Stewart said.

And she stressed the importance of examining state and local requirements for testing and reporting as these, too, must be followed.

“Many states use emergency room trends as a way to pick up community activity,” she said.

She offered this link to help identify emergency room visits of patients with COVID symptoms.