Nebraska Medicine changes pre-procedural, admission policy

Nebraska Medicine now is presuming the omicron variant is the source of all new COVID-19 infections in the Omaha community. Because of the transmissibility of omicron, beginning today, the hospital will test all patients who require a hospital admission or are scheduled for a procedure or a surgery, including those who experienced a COVID-19 infection within the last 90 days. There are no changes to the list of procedures that require testing.

"For simplicity, any patient who tested positive for COVID-19 prior to Jan. 7, 2022, is presumed to have had a delta variant infection but remains at risk for an omicron infection," said Kelly Cawcutt, MD, medical director, medical quality, and associate medical director, infection control and epidemiology.

Beginning Friday, Jan. 7:

Patients admitted to the hospital will continue to be tested for COVID-19 but will now include those who experienced a COVID-19 infection within the last 90 days.
Patients scheduled for a procedure or surgery on Monday, Jan. 10, or later must be tested for COVID-19, including those who experienced a COVID-19 infection within the last 90 days. There are no changes in the list of procedures that require testing.
Patients with acute COVID-19 infection occurring on or after Friday, Jan. 7, will be managed as previously with deferral of repeat testing for 90 days.

"For patients who test positive on or after Jan. 7, we understand there may be clinical questions arising regarding if the positive test represents prolonged viral shedding from a past delta variant infection or a new infection with omicron," Dr. Cawcutt said. "If these questions arise, options for procedures will be to proceed with the procedure with COVID-19 level precautions, postponing for 21 days or consulting with experts to better to differentiate situation, which may require serial testing. Similarly, if questions for hospital isolation arise, appropriate COVID-19 precautions should always be used and expert consultation can be used to determine if 21 days of isolation will be required."

Additional notes for health care teams

Patients with elective procedures included in pre-procedure testing scheduled on Monday, Jan. 10, or later will require COVID-19 testing

If there is any concern, clinically or with possible exposure to COVID-19, Nebraska Medical Center strongly encourages repeat testing for COVID-19.

Patients who have had COVID-19 in the last 90 days may test positive for a prolonged period of time. In this setting, if the procedure is urgent/emergent, it can proceed under COVID-19 precautions as per prior protocols. If the procedure can be delayed, a physician can defer for 21 days as per past protocols. Finally, if you would like to reschedule earlier than 21 days, please contact COVID ID, and a decision can be made on the value of repeat testing to attempt to ascertain if this is persistent viral shedding from a past delta infection or a new infection with omicron.

For new admissions with a positive screening test, if concerns arise regarding if this is an old or new infection, please contact COVID ID for further assessment.

There are no changes to duration of isolation or exit of isolation policies for the inpatient setting. If a patient is within 21 days of a COVID-19 infection, they should be in COVID-19 precautions in the hospital (regardless of if they exited CDC home-based isolation). Earlier exit from isolation can occur through established protocols only.

Nebraska Medicine changes pre-procedural, admission policy

Additional notes for health care teams

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