BMJ public health · 2026
Large-scale COVID-19 asymptomatic testing using lateral flow devices (LFDs) in reducing nosocomial infections and healthcare worker absenteeism: an observational study and cost-effectiveness analysis in NHS acute trusts in England.
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Chen Siyu, Hounsell Rachel, Cantrell Liberty, Tsui Lok Hei, Naidoo Reshania, Dahal Prabin, Creswell Richard, Bajaj Sumali, Flegg Jennifer A, Fowler Tom, Hopkins Susan, Lambert Ben, Voysey Merryn, White Lisa, Stepniewska Kasia, Shretta Rima, EY-Oxford Health Analytics Consortium
Аннотация
INTRODUCTION: Twice-weekly lateral flow device (LFD) testing for asymptomatic healthcare workers (HCWs) was introduced in the National Health Service (NHS) in England in November 2020. We retrospectively examine associations between LFD testing, nosocomial infections and HCW absenteeism at NHS acute trusts.
METHODS: We collected 16 million LFD testing results reported by NHS acute trusts from 1 October 2020 to 30 March 2022 and estimated the prevalence of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). We used a mixed-effects linear model to examine the association between full-time equivalent (FTE) days lost due to COVID-19 and LFD test coverage. The relationship between weekly prevalence of nosocomial infections and LFD test coverage in the previous week was modelled using logistic regression weighted by the number of new COVID-19 cases reported in the ISARIC dataset for that week. We conducted an analysis of cost-effectiveness of testing for nosocomial infections.
RESULTS: Increased LFD test coverage was associated with decreases in FTE days lost due to COVID-19 from November 2020 to July 2021, with no association observed from August 2021 to March 2022. The proportion of nosocomial infections among new weekly cases in hospitalised patients was negatively associated with reported LFD testing levels.
CONCLUSIONS: Higher LFD test coverage was associated with lower HCW absenteeism (November 2020-July 2021) and with a lower proportion of nosocomial infections among hospitalised patients. Given the retrospective, ecological design, these are associations rather than causal effects, and the cost-effectiveness estimates are valid only if the observed association reflects a causal effect of testing rather than confounding by co-occurring interventions or temporal trends in the pandemic. Under that assumption, LFD testing would have been a cost-effective measure for reducing nosocomial infections in NHS acute trusts.
METHODS: We collected 16 million LFD testing results reported by NHS acute trusts from 1 October 2020 to 30 March 2022 and estimated the prevalence of nosocomial COVID-19 infections in NHS acute trusts using data from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). We used a mixed-effects linear model to examine the association between full-time equivalent (FTE) days lost due to COVID-19 and LFD test coverage. The relationship between weekly prevalence of nosocomial infections and LFD test coverage in the previous week was modelled using logistic regression weighted by the number of new COVID-19 cases reported in the ISARIC dataset for that week. We conducted an analysis of cost-effectiveness of testing for nosocomial infections.
RESULTS: Increased LFD test coverage was associated with decreases in FTE days lost due to COVID-19 from November 2020 to July 2021, with no association observed from August 2021 to March 2022. The proportion of nosocomial infections among new weekly cases in hospitalised patients was negatively associated with reported LFD testing levels.
CONCLUSIONS: Higher LFD test coverage was associated with lower HCW absenteeism (November 2020-July 2021) and with a lower proportion of nosocomial infections among hospitalised patients. Given the retrospective, ecological design, these are associations rather than causal effects, and the cost-effectiveness estimates are valid only if the observed association reflects a causal effect of testing rather than confounding by co-occurring interventions or temporal trends in the pandemic. Under that assumption, LFD testing would have been a cost-effective measure for reducing nosocomial infections in NHS acute trusts.