Reminder: Clinical guidance for SARS-CoV-2 infection

Pre-procedural testing is required for patients undergoing general anesthesia, regional anesthesia (not a field block) as a primary anesthetic [as airway manipulation would be needed in the event of block failure] or other procedures as approved by the VUMC COVID-19 Command Center.

Pre-procedural testing is specifically not required for the following:

• Eye surgery where minimal or moderate sedation is used, including moderate sedation with retrobulbar block (if general anesthesia is used, pre-procedural testing is required)
• Any surgery where a field block plus minimal/moderate sedation is used with very low chance of converting to general anesthesia
• Colonoscopy
• Patients diagnosed with laboratory-confirmed COVID-19 within the past 90 days (unless a patient has developed new symptoms concerning for reinfection).
• (NEW) Patients who are fully vaccinated and not significantly immunocompromised.  Patients must present documentation that they have completed the required doses (two doses of a 2-dose vaccine or one dose of a single-dose vaccine) of a COVID-19 vaccine more than 14 days prior to the planned procedure. COVID-19 vaccine booster doses are not required to be exempted from pre-procedural COVID-19 testing.

[NOTE: Some external guidance advocates for testing and deferment of surgical procedures for some COVID-19 infected patients (including unvaccinated patients) in relation to a possible increased risk of post-operative complications. The above guidance only reflects testing to mitigate pathogen transmission in the procedural spaces. The scheduling proceduralist or other attending physician should be consulted to determine pre-procedural testing requirements for patients who may be at greater risk of post-operative complications.

ADMISSION TESTING FOR SARS-CoV-2 IN ASYMPTOMATIC PATIENTS:

All patients are tested on admission except for the following:

• Patients diagnosed with laboratory-confirmed COVID-19 within the past 90 days (unless a patient has developed new symptoms concerning for reinfection).
• Patients who had a SARS-CoV-2 PCR test collected in the 72 hours prior to admission.
• Positive SARS-CoV-2 antigen tests from outside facilities in the past 20 days in patients with symptoms consistent with COVID-19. Positive antigen tests in patients with no symptoms consistent with COVID-19 should be confirmed with a SARS-CoV-2 PCR, but the patient should be placed in appropriate isolation while the confirmatory test is pending. Negative antigen tests are not acceptable, and a SARS-CoV-2 PCR should be ordered on admission.
• (NEW) Patients who are fully vaccinated who are not significantly immunocompromised and who are not being admitted to positive pressure units.  Patients must present documentation that they have completed the required doses (two doses of a 2-dose vaccine or one dose of a single-dose vaccine) of a COVID-19 vaccine more than 14 days prior to the admission.  COVID-19 vaccine booster doses are not required to be exempted from admission COVID-19 testing.  Patients admitted to positive pressure units (11N, 10 CCT, 6A/B) require admission testing regardless of vaccination status.