Is a COVID-19 PCR test required pre-op for all patients undergoing elective surgery, including dental surgery? 

Posted on June 9, 2020 by Madalon Burnett

Summary

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:
  1. Availability, accuracy and current evidence regarding tests, including turnaround time for test results.
  2. Frequency and timing of patient testing (all/selective).
    1. 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.
    2. 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.
  3. Indications and availability for health care worker testing.
  4. 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)

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. 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
  2. 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
  3. 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
  4. 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#
  5. ‌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
  6. ‌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 

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.