Testing at the bedside . . . and other storiesBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1942 (Published 27 April 2017) Cite this as: BMJ 2017;357:j1942
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I have studied the research findings of point of care testing for respiratory viruses published in the Lancet with interest.
Firstly, I am not at all surprised that the findings did not confirm lower use of antimicrobials at the positive PCR arm for respiratory viruses as viral lower respiratory tract infections are often associated with secondary bacterial infections hence requiring systemic antimicrobial treatment.
The second dimension is the fact that detection of a virus will assist in making a decision whether to isolate and barrier nurse (including using appropriate masks as personal protective equipment) a patient or not. The detection of Influenza A or B is more significant than the detection of other respiratory viruses that cause common cold such as Coronavirus and Rhinovirus. The ideal practice is to isolate all patients with respiratory viruses even those that cause common colds as the spread of this mild infection amongst staff is undesirable. But in the face of shortage of isolation facilities, many organisations do not have the capacity to isolate such patients infected with common cold viruses.
The usual infection prevention control practice once a decision is made to test for respiratory viruses -- namely, by using viral swabs and doing PCR (polymerase chain reaction) testing -- is to automatically isolate patients. But in view of the shortage of isolation facilities, many organisations quantify the risk initially on clinical grounds to establish if it is likely to be Influenza A or B and then make a decision whether to isolate or not before the PCR tests are available.
Competing interests: No competing interests