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Wednesday, May 18, 2022

Despite ICMR guidelines, hospitals liberal with testing

🔴 “Asymptomatic patients undergoing surgical/non-surgical invasive procedures including pregnant women in/near labour who are hospitalised for delivery should not be tested unless warranted or symptoms develop,” the new guidelines read.

Written by Anonna Dutt | New Delhi |
Updated: January 18, 2022 7:40:12 am
Huge crowd seen at Covid-19 testing centre at a government hospital in Noida | Express photo by Gajendra Yadav

Several hospitals in Delhi are still testing patients for Covid-19 at the time of admission and before procedures to prevent in-hospital transmission, despite the new testing guidelines issued by the Indian Council of Medical Research (ICMR) stating that asymptomatic patients should not be tested. Doctors also fear that the surgical outcomes could be worse in patients with an active infection.

“Asymptomatic patients undergoing surgical/non-surgical invasive procedures including pregnant women in/near labour who are hospitalised for delivery should not be tested unless warranted or symptoms develop,” the new guidelines read.

The number of Covid-19 tests in the capital has dipped sharply since the new guidelines did away with testing on demand for asymptomatic patients, low-risk contacts of a positive patient, and asymptomatic persons in hospital for other procedures.

A senior official from the Delhi government told The Indian Express that sample collection by the government had dropped by two-thirds after the guidelines came into force.

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At the All India Institute of Medical Sciences (AIIMS), a senior administrator said, “The guidelines have been issued by the ministry and we have to implement it.”
Doctors from the hospital, however, said that tests were being conducted routinely before admitting patients, shifting patients to other wards, as well as before procedures.

“Unless it is an emergency life-threatening condition, we do test the patients before any procedures. The patients are also tested before they are moved from one ward to the other. There is no work-around. Even an asymptomatic person can give the infection to the other sick patients in a ward and then we do not know who will get a severe disease. Not to mention healthcare workers getting exposed,” said a doctor from the hospital, on condition of anonymity.

At Safdarjung Hospital, patients are tested using a rapid antigen kit during admission. They are moved to the isolation ward in the Super Speciality Block if they test positive; if they are symptomatic but test negative they are sent to the suspect block in the same building; if they are asymptomatic and test negative they are admitted to other wards.

“Patients undergo so many tests when they have to get a procedure at the hospital. Adding a Covid-19 test doesn’t increase the time and effort too much. Not doing it would mean exposing countless others to the infection. We do ask for the test when patients have to undergo any surgery or tests such as CT scan or MRI,” a doctor from the hospital said.

Given how transmissible the new variant is, scores of healthcare workers have tested positive over the past few weeks, resulting in a shortage of manpower.

“Seventy one of our 380 nurses tested positive within three days of cases starting to increase. It was becoming very difficult to run the hospital. But that is not the only reason we get our patients tested before a planned surgery,” said Dr Sumit Ray, medical superintendent of Holy Family Hospital.

He said, “There is no evidence so far to suggest that the surgical outcome will not be worse in those with an active infection. The outcomes for patients with Covid-19 were bad during the two previous waves. If it is an emergency life-saving surgery, of course, it needs to happen and is conducted without the test. But why take a chance with an elective surgery; they can just come back in 10 days or so and get it.”

Another senior doctor from a prominent private hospital in the city said, “We are also answerable to the families. What if other people in a ward get infected or the outcome of a surgery is not good? We will be sued. We have to do the test.”

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