Dear Member:
The New Jersey Department Of Health (DOH) had a productive week resulting in some good news for all long term care (LTC) centers. Not only has DOH approved the Quidel Sofia 2 SARs Antigen FIA and BD Veritor System for Rapid Detection of SARS-COV-2 antigen test kits for use, they also announced that Rutgers saliva-based tests are available for purchase. Here is what you need to know about both tests:
Preparation for administering and processing the antigen tests:
- Trained staff should have documented competency tests ensuring they are capable to administer the antigen test. If there are additional questions about testing, contact the test kit company directly for guidance. Evidence has shown that a lack of knowledge about proper collecting and processing of the tests has resulted in false positives.
- Have sufficient quantities of Personal Protective Equipment (PPE) available on site for staff administering and processing the tests. Staff collecting specimens that are potentially infected with COVID-19 are at the highest risk for infection and must use all appropriate PPE: gowns, gloves, masks and, if available, face shields.
- Please remember that PCR tests are always acceptable for use in all testing circumstances.
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DHS has provided guidance for how and in what circumstances the antigen tests should be used. The Appendix section of the document provides antigen testing information for both active outbreak and non outbreak circumstances and when a PCR follow up test is required. These guidelines are summarized below.
- In LTC centers with no active outbreak:
- Health Care Personnel (HCP) must be tested weekly per E.D. 20-26
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If the employee is asymptomatic and the antigen test result is negative:
- Employee is presumed negative. Continue with weekly routine testing.
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If the employee is asymptomatic and the antigen test result is positive, follow up with a PCR test within 48 hours and exclude the employee from work until the test results are reported to the center.
- If the PCR test result is negative contact Local Public Health (LPH) to determine next steps.
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If the employee is symptomatic and the antigen test result is positive, the employee must be excluded from work per current CDC guidelines
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If the employee is symptomatic and the antigen test result is negative, follow up with a PCR test within 48 hours and exclude the employee from work until the test results are reported to the center.
- If the PCR test result is also negative contact Local Public Health (LPH) to determine next steps.
- In LTC Centers with an active outbreak:
- Both residents and staff must be tested.
For Residents:
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If the resident is asymptomatic and the antigen test result is positive, no confirmatory test is required.
- Resident must be isolated and Transmission Based Precautions (TBP) implemented.
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If the resident is asymptomatic and the antigen test result is negative, no confirmatory test is required.
- Continue with TBP as a Person Under Investigation (PUI).
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Continue with weekly testing of residents per E.D. 20-026 until no new positive test results are reported for at least 14 days.
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If a resident is symptomatic and the antigen test result is positive, no confirmatory test is required.
- The resident must be isolated and TBP implemented.
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If a resident is symptomatic and the antigen test result is negative, perform a PCR test within 48 hours, maintain the resident on TBP until the PCR test results are reported.
For Staff:
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If an employee is asymptomatic and the antigen test result is positive no confirmatory test is needed.
- Exclude the employee from work in accordance with current CDC guidance.
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If an employee is asymptomatic and the antigen test result is negative, no confirmatory test is needed.
- Employee can continue working, continue weekly testing of all HCP.
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If an employee is symptomatic and the antigen test result is positive, no confirmatory test is required.
- Employee must be excluded from work with return to work protocols as per CDC guidance
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If an employee is symptomatic and the antigen test result is negative, perform a PCR test within 48 hours and exclude the employee from work until receipt of the PCR test results.
- Depending on the PCR test results employee will remain excluded from work based on CDC guidance or policies and procedures if symptoms are a result of an illness other than COVID-19.
Additional resources available when conducting antigen tests:
RUTGERS SALIVA TESTS
On September 25, 2020 NJDOH announced that PCR saliva-based COVID-19 tests are now available for purchase. These kits allow specimens to be collected on site and sent to a Rutgers contracted lab for processing.
- A CLIA certificate of waiver is not required for this type of test.
- The anticipated state monies that will be disbursed to all LTC centers based on a pre determined formula is not mandated for use only to purchase the Rutgers tests.
- The cost of the test is dependent on the way it is administered:
- Test kits mailed home to employees who are suspected positive for COVID-19 - $122
- Tests conducted onsite by Vault, with specimen transport managed by Vault - $100.60
- Specimen collection managed by LTC center staff and specimen transport managed by the LTC center - $83.60
Advantages of this type of PCR test:
- Infinity Biologics guarantees a 72 hour turnaround time for test results
- The lab completes all the reporting requirements
- The test is saliva based, eliminating the repeated discomfort from the naso pharyngeal PCR test
Disadvantages:
Depending on the laboratory contract currently in place at a LTC center, Rutgers saliva-based tests may not offer any benefit other than comfort, as long the contracted laboratory is able to provide test results within 72 hours.
The choice to use Rutgers saliva-based tests will be determined by each LTC center depending on current needs and satisfaction with the current PCR testing contract currently in use. Consider the Rutgers saliva-based PCR test as another option.
In the near future, the BinaxNOW COVID-19 Ag card is expected to be available for use in all LTC centers. The cost is $5-15, has a 15 minute turnaround time for results, and does not require any special processing equipment.
Even with all the new and rapidly evolving availability and reliability of COVID-19 antigen tests; for the moment, continue to maintain a relationship with a laboratory to have PCR testing available as needed whether it be a saliva or nasopharyngeal testing option.
Jan Siegal
Director, Quality, Clinical & Regulatory Services
609-890-8700