COVID-19 Screening Clinical Pathway — Inpatient | Children's Hospital of Philadelphia

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Inpatient SARS-CoV-2 Testing Recommendations

Testing Indications
- All Patients on Admission Universal Testing on Admission, Patient Placement
- Pre-procedure, if test not performed in last 72 hours or 3 days, or if new symptoms
- Current inpatients with new infectious symptoms concerning for COVID-19

Huddle Performed for Patients Admitted with COVID Exposure or COVID Infection
1. Indications for testing
  - Screening Test: Pre-admission/Pre-procedural in an Asymptomatic Patient
  - Diagnostic Test: Symptomatic or Exposed Patients to detect Disease
2. Exposure — Full Exposure Definition with Examples
  - Prolonged (> 15 minutes), close (< 6 feet) contact with a person who is COVID-positive
3. Patients receiving Aerosol Generating Procedures (AGP)
  - Charge RT and team huddle to determine if AGPs can be held or strategies for risk reduction can be employed pending test results

Review the Following to Determine Precautions for Patients with Pending SARS-CoV-2 Tests*
	Exposure	AGP	Precautions
Asymptomatic (Screening)	No	No	Standard (Review if precautions for alternate infections are required)
	No	Yes**	Expanded; Single negative pressure room, door closed
	Yes	No	Modified Expanded; Single room with door closed
	Yes	Yes	Expanded; Single negative pressure room, door closed
Symptomatic (Diagnostic)	No	No	Modified Expanded; Single room with door closed
	No	Yes	Expanded; Single negative pressure room, door closed
	Yes	No	Modified Expanded; Single room with door closed
	Yes	Yes	Expanded; Single negative pressure room, door closed
If symptoms and/or exposures are unknown/unclear, assume the patient is symptomatic and/or exposed while the test result is pending. *Asymptomatic and unexposed patients who require an AGP, but have tested negative on admission should remain on standard precautions if repeat testing is needed prior to a procedure.

SARS-CoV-2 Results Available
	Not Receiving AGP	Receiving AGP
COVID Positive	Modified Expanded Precautions	Expanded Precautions
	Place in a Special Treatment Room Negative Pressure room not required Single room, door must remain closed Consider ID consult Test bedside caregivers if patient with a negative test on admission subsequently tests positive Caregiver Guidance	Place in a Special Treatment Room Negative Pressure Rooms required Single room, door must remain closed Consider ID consult Test bedside caregivers if patient with a negative test on admission subsequently tests positive Caregiver Guidance
COVID Negative No Exposure	Isolation precautions based on symptoms Negative pressure room not required
COVID Negative Exposure	Modified Expanded Precautions Negative pressure room not required Single room Door must remain closed	Expanded Precautions Place in a Special Treatment Room Negative Pressure Rooms required Door must remain closed Single room, door must remain closed Consider ID consult Test bedside caregivers if patient with a negative test on admission subsequently tests positive Caregiver Guidance

Guidance for Discontinuation of Precautions

If exposed, bedside caregivers may need to continue their quarantine after the patient is considered COVID-recovered. Refer to Management of Parents/Caregivers with Exposure to or Symptoms of COVID-19.

Resources

Posted: March 2020
Revised: January 2023
Authors: C. Kerman, MD; D, Davis, MD; K, O’Callaghan, MD; K. Chiotos, MD; J. Lavelle, MD; L. Handy, MD; J. Sammons, MD

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Inpatient Clinical Pathway for Screening/Evaluation of Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

Evidence

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