Guidance

[Withdrawn] Recommendation 2: change the pre-procedure testing advice prior to elective procedures or planned care

Updated 19 October 2021

This guidance was withdrawn on 22 April 2022

The information in this document has been superseded by Infection prevention and control for seasonal respiratory infections in health and care settings (including SARS-CoV-2) for winter 2021 to 2022.

Where changes are made locally to COVID-19 control measures, organisations are responsible for undertaking appropriate risk assessments, approved through local governance processes, to ensure that patient and staff safety is not compromised. For example, consideration of local factors, such as infection prevalence, patient mix and bed availability, need to be considered for the management of contacts of confirmed cases of SARS-CoV-2.

Context

The National Institute of Health and Care Excellence (NICE) published guidance (NG 179) in July 2020 on arranging planned care in hospitals and diagnostic services, which recommended that patients:

• follow comprehensive social-distancing and hand-hygiene measures for 14 days before admission
• have a PCR test for SARS‑CoV‑2 no more than 3 days before admission, and ensure the results are available beforehand
• self-isolate from the day of the test until admission

Recommendation

Assess the need for a negative PCR and 3 days self-isolation before certain elective procedures on selected low risk patients who are fully vaccinated, asymptomatic and not a contact of case suspected/confirmed case of COVID-19 within the last 10 days. Instead, these patients can take a lateral flow test (LFT) on the day of the procedure. The use of an expanded defined symptom checklist could be introduced if local providers consider it helpful to identify patients with upper respiratory tract symptoms, but this will not be recommended at a national level. For some settings and services, the continuation of PCR testing will provide safe patient flows, however the use of LFTs allows for more responsive service provision for some patients based on local risk assessment.

Patients who are a contact of a confirmed case of SARS-CoV-2 will still need to go through the current NICE PCR pathway as set out in NG 179: COVID-19: management of staff and exposed patients or residents in health and social care settings.

Providers of healthcare will need to undertake local risk assessments to determine where it will be safe to implement this approach to pre-procedure testing. Clear information will need to be provided to patients on pre-procedure requirements. Staff caring for these patients should be fully vaccinated, asymptomatic and continue to comply with the current guidance on asymptomatic testing, and the management of staff and exposed patients or residents in health and social care settings

Patients will still be required to wear face coverings and staff will be required to wear fluid repellent surgical face masks for source control. The importance of hand and respiratory hygiene should be emphasised.

The Code of Practice on the prevention and control of infection and related guidance (2015) expects providers of regulated activities to have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.

Evidence

The UK Health Security Agency has consulted a range of clinicians and IPC specialists on whether the advice in relation to pre-procedure testing and self-isolation can be amended for low risk patients requiring elective procedures. They are supportive of the proposed approach.