Is a COVID-19 PCR test required pre-op for all patients undergoing elective surgery, including dental surgery?Posted on by
The need for a COVID-19 PCR test prior to surgery depends on the amount of community transmission in the area and whether the patient feels symptoms. In BC, asymptomatic patients do not require a test swab prior to surgery because community transmission is currently low. If patients have symptoms suggesting COVID-19 they should have a PCR test prior to their surgery if possible. Recommendations are different in other geographical areas because of different rates of community transmission.
I. BC Guidelines
- The BCCDC also has a document offering guidance for all surgical procedures in the province (1):
- “Based on the current epidemiology of COVID-19 in B.C., people who are scheduled for surgery and do not have risk factors for or symptoms of COVID-19 should not be considered suspect cases.”
- “In most cases, patients who do not have risk factors for, or symptoms consistent with COVID-19 do not require a COVID-19 test.”
- “For urgent or emergent surgical procedures, patients reporting new symptoms consistent with COVID-19 should undergo pre-operative COVID-19 testing.”
- “Elective surgical patients reporting new symptoms consistent with COVID-19 should be tested as per provincial testing guidelines.”
- The BCCDC has a document offering guidance for infection prevention for Surgery in a non-hospital medical surgical facility. It is not required to test all patients for COVID-19 prior to their procedures. Testing recommendations are (2):
- “Patients reporting new symptoms consistent with COVID-19 should be tested as per provincial testing guidelines.”
- “All patients should have their temperature measured on arrival to the facility.”
- The College of Dental Surgeons of BC has a document on oral health care in Phase 2 of the COVID-19 response plan. They do not mention a requirement for pre-operative COVID-19 testing, though they do require that patients be pre-screened before arriving for their appointment by asking about symptoms and possible exposures to COVID-19. (3)
II. Canadian Guidelines
- The Canadian Anesthesiologists’ Society recommends in their position statement on reinstitution of elective operations following COVID-19: “All patients from areas with ongoing community transmission, should undergo COVID-19 Polymerise Chain Reaction (PCR) testing during their pre-admission visit.” (4)
III. American Guidelines
- Testing considerations from a joint statement from the American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, and American Hospital Association (5):
- “Principle: Facilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testing.
- Considerations: Facility COVID-19 testing policies should account for:
- Availability, accuracy and current evidence regarding tests, including turnaround time for test results.
- Frequency and timing of patient testing (all/selective).
- Patient testing policy should include accuracy and timing considerations to provide useful preoperative information as to COVID-19 status of surgical patients, particularly in areas of residual community transmission.
- If such testing is not available, consider a policy that addresses evidence-based infection prevention techniques, access control, workflow and distancing processes to create a safe environment in which elective surgery can occur. If there is uncertainty about patients’ COVID-19 status, PPE appropriate for the clinical tasks should be provided for the surgical team.
- Indications and availability for health care worker testing.
- How a facility will respond to COVID-19 positive worker, COVID-19 positive patient (identified preoperative, identified postoperative), “person under investigation” (PUI) worker, PUI patient.”
- The American Society of Dentist Anesthesiologists recommends: “Without adequate testing, it is prudent to practice airborne precautions with any aerosol-generating procedure because asymptomatic patients are known to contribute to the transmission of the virus.” (6)
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- Infection Prevention and Control (IPC) Protocol for Surgical Procedures During COVID-19: Adult Guiding Principles: Approach to IPC Includes: Provider Safety Patient COVID-19 Assessment Patient Safety Surgical Risk Assessment PPE Conservation PPE Recommendation PPE Allocation Framework [Internet]. 2020. Available from: http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID19_IPCProtocolSurgicalProceduresAdult.pdf
- COVID-19: Infection Prevention and Control Guidelines for Surgery in Non- Hospital Medical Surgical Facilities [Internet]. 2020 [cited 2020 Jun 13]. Available from: http://www.bccdc.ca/Health-Professionals-Site/Documents/IPC_Guidance_Surgeries_Non-Hospital_Sites.pdf
- Information on COVID-19 [Internet]. Cdsbc.org. 2015 [cited 2020 Jun 10]. Available from: https://www.cdsbc.org/about-cdsbc/news/covid-19/covid-19-for-registrants
- CAS Position Statement – Reinstitution of Elective Operations following COVID-19 [Internet]. Informz.ca. 2020 [cited 2020 Jun 10]. Available from: https://cas.informz.ca/informzdataservice/onlineversion/ind/bWFpbGluZ2luc3RhbmNlaWQ9MTIwMTgxNyZzdWJzY3JpYmVyaWQ9OTA4MTcxMjk1#
- Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic | American Society of Anesthesiologists (ASA) [Internet]. Asahq.org. 2020 [cited 2020 Jun 10]. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic
- The American Society of Dentist Anesthesiologists Interim Guidance for Dentist Anesthesiologists Practicing in the Office-Based Setting During the COVID-19 Pandemic [Internet]. [cited 2020 Jun 10]. Available from: https://old.asdahq.org/sites/default/files/Guidance%20ASDA%205.7.20_0.pdf
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