A new study has shown that rapid bedside testing reduces the wait time for results and can improve infection control in hospitals.
The international study, which is the first to assess the real-world impact of point-of-care testing close to a patients bedside, suggests that these tests might have a clinical advantage over widely used polymerase chain reaction (PCR) methods. It tracked COVID-19 testing on admission to a UK hospital, finding that that the wait for results was just 1.7 hours using point-of-care testing (POCT) close to the patient’s bedside, compared with 21.3 hours using standard PCR testing in a centralised lab within the hospital.
The study has been published in The Lancet Respiratory Medicine journal.
Point of care testing
The findings suggest that testing suspected COVID-19 at the point-of-care could help healthcare providers better manage a surge in cases and reduce infection spread within the hospital. Delays in PCR test results, which were relied on in the first wave of the pandemic, mean that it takes longer for patients to be admitted to the correct COVID or non-COVID wards. Patients are then waiting in mixed assessment rooms, increasing the possibility of transmission between positive and negative patients.
Now that a number of molecular POCT testing platforms have been developed, rapid results are improving, and swab samples are placed into test cartridges that take up little physical space and can be operated by health-care staff, unlike the standard laboratory PCR test. Although there is data to support the speed and accuracy of POCT kits, there remains a lack of insight into their impact on hospital care and transmission.
Preparing for a second wave
As hospitals prepare for a second wave of the pandemic, rapid testing of suspected cases of COVID-19 will be key to containment and preventing hospitals from becoming overwhelmed.
Dr Tristan William Clark, lead author from Southampton General Hospital, UK, said: “Our findings are the first to suggest the clinical benefits of molecular point-of-care COVID-19 testing in hospitals, demonstrating reduced delays, bed moves, and time in assessment areas, which all lead to better infection control. We believe that molecular POCTs should be urgently integrated into care pathways to reduce coronavirus transmission within hospitals to prevent the next wave of the pandemic overwhelming health services around the world.”
The non-randomised trial took place in the Acute Medical Unit and Emergency Department of Southampton General Hospital and included adults with COVID-19 symptoms.
The authors compared how long it took to receive results with the two types of testing. Secondary analyses (planned outcome measures that are not as important as the primary outcome measure but are still of interest in evaluating the effect of an intervention) looked at infection control and diagnostic accuracy. The results found that with POCT turn around was 1.7 hours compared with 21.3 hours, and there still remained a significant difference after taking into account factors such as disease severity, age, and sex.
After testing, patients were transferred to definitive COVID-positive or negative wards. This took 8 hours in the POCT group, compared with 28.8 hours in the control group, with 13.7% transferred directly to the correct ward (bypassing assessment areas) in the POCT group and 0% in the control group. The mean number of bed moves between admission and final ward arrival was lower in the POCT group at 0.9 moves than in the control group at 1.4 moves.
The findings provide evidence that POCT for COVID-19 is feasible in the context of appropriate infection control and staff training. The study could inform decision making around patient diagnostics and containment as the pandemic continues.
“Recruiting patients into clinical trials remains an international priority throughout this pandemic and is vital to accelerating the search for effective treatments”, says Dr Clark. “This is especially true when researchers are investigating the potential of anti-virals, which have to be administered at early disease stages to have the greatest benefit.”
The authors caution that there are limitations to the study, most notably that they were unable to randomise the groups due to staffing resources, and there were differences in baseline measures of a number of factors, with the POCT group showing more severe disease.
The authors further caution that POCT must always be carried out under appropriate infection control guidelines and with trained staff, and that the findings may not extend to non-hospital settings.