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Pool Testing

Posted

Specializes in school nurse. Has 29 years experience.

I'm just rolling out BinaxNow tests at my school this coming Monday and now the state has publicized and encouraged signing up for a pilot program in which we'd do weekly pool testing of the entire school.

Positive pools to be followed up by individual BinaxNow tests of everyone in that pool.

Ah, no.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

On 1/9/2021 at 1:54 PM, Jedrnurse said:

I'm just rolling out BinaxNow tests at my school this coming Monday and now the state has publicized and encouraged signing up for a pilot program in which we'd do weekly pool testing of the entire school.

Positive pools to be followed up by individual BinaxNow tests of everyone in that pool.

Ah, no.

Are you in MA like me? Is this is the Baker initiative? My real concern is the BinaxNow testing is supposed to be for symptomatic folks only; the pooled testing is for asymptomatic folks. Therefore, I'm not sure the follow-up BinaxNow test is actually going to work as well as they think...

I do weekly testing of all my in person staff and students, which right now is high needs students so I'm testing about 100 folks a week. I have a great partner and we are doing individual PCR testing with results that turn around in ~24 hours. But I'm also working with some EMS partners to do some swabbing because I cannot do it all myself. I'm managing all the back end admin stuff and it is a LOT. 

We will be moving to pooled testing for students only (continuing individual PCR for staff) in Feb because we can't afford to keep testing everyone if we add in more students. I'm doing a trial with some volunteers the first week of February. 

(I will say, I opted out of the BinaxNow testing in the first round in MA. I just had a lot of questions about it, am trying to avoid symptomatic folks (both staff and students) from entering using a screening tool. But since we were launching our weekly surveillance testing program at the same time I had to opt in, I also just wanted to stick to the PCR option at first and relook at it after some more data.)

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

12 minutes ago, JenTheSchoolRN said:

Are you in MA like me? Is this is the Baker initiative? My real concern is the BinaxNow testing is supposed to be for symptomatic folks only; the pooled testing is for asymptomatic folks. Therefore, I'm not sure the follow-up BinaxNow test is actually going to work as well as they think...

I do weekly testing of all my in person staff and students, which right now is high needs students so I'm testing about 100 folks a week. I have a great partner and we are doing individual PCR testing with results that turn around in ~24 hours. But I'm also working with some EMS partners to do some swabbing because I cannot do it all myself. I'm managing all the back end admin stuff and it is a LOT. 

We will be moving to pooled testing for students only (continuing individual PCR for staff) in Feb because we can't afford to keep testing everyone if we add in more students. I'm doing a trial with some volunteers the first week of February. 

(I will say, I opted out of the BinaxNow testing in the first round in MA. I just had a lot of questions about it, am trying to avoid symptomatic folks (both staff and students) from entering using a screening tool. But since we were launching our weekly surveillance testing program at the same time I had to opt in, I also just wanted to stick to the PCR option at first and relook at it after some more data.)

Yeah, I'm in MA. The contradictions are one thing that gets me. They want a positive pool to be tested with BinaxNow, but won't accept a BinaxNow negative as sufficient (when done for symptomatic people) and want PCR confirmation in those cases. Also in the pool testing scenario, the funding lasts for six weeks then the school has to absorb the costs...

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

4 minutes ago, Jedrnurse said:

Yeah, I'm in MA. The contradictions are one thing that gets me. They want a positive pool to be tested with BinaxNow, but won't accept a BinaxNow negative as sufficient (when done for symptomatic people) and want PCR confirmation in those cases. Also in the pool testing scenario, the funding lasts for six weeks then the school has to absorb the costs...

Yep! All reasons I don't like as well. 

Also for reflex testing with the BinaxNow testing (which again, the data for it is based on testing symptomatic folks, not asymptomatic), you still need to the get the student/staff member back to do the test. Staff for me is easier, but being in an urban area, I have many, many kids that rely on public transit or school bus. They may need to Uber - they may not be able to afford to. And I realize I'm asking a potentially positive person to transport themselves in a way they can expose others. (Which happens all the time when symptomatic folks need testing and don't own a car, but here I'd actually know it and that feels kinda dirty to me.)

The pooled option I'm looking at it isn't free for six weeks, but it with a trusted vendor and lab and has a quick follow-up PCR option. 

Basically I can call in students to reswab and send out immediately for individual PCR test - lab is local. But also exploring the idea of swabbing kids x2 initially. Swabbed sample is stable for up to 54 hours, and I'd get the pooled results in <24 hours, then look at my individual samples, pluck the ones needed and sent them out immediately so the process overall can take less then 48 hours. No need for folks to come in again. I'm really trying to avoid bringing a positive person back into the building if I can avoid it. 

 

 

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

2 hours ago, JenTheSchoolRN said:

 

Basically I can call in students to reswab and send out immediately for individual PCR test - lab is local. But also exploring the idea of swabbing kids x2 initially. Swabbed sample is stable for up to 54 hours, and I'd get the pooled results in <24 hours, then look at my individual samples, pluck the ones needed and sent them out immediately so the process overall can take less then 48 hours. No need for folks to come in again. I'm really trying to avoid bringing a positive person back into the building if I can avoid it. 

 

 

Not to get too much in the weeds on this, but is storage of bio-samples in a school allowed under the CLIA certificate?

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

Holy sheets!

Please keep us updated. I believe I understand the point of the Binax is that it's used on symptomatic kids and is fairly effective at saying "yes, they have it."

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

42 minutes ago, Jedrnurse said:

Not to get too much in the weeds on this, but is storage of bio-samples in a school allowed under the CLIA certificate?

This is what I'm looking into. To run my current testing, I actually don't need the CLIA certificate because the partnership includes an outside lab running the samples I immediately send out. The BinaxNow has you run the samples on site so you are the lab essentially, so that is where the fine line is, I believe...

Edited by JenTheSchoolRN

Just curious how do the parents feel about all of this testing?  Is it a requirement for Face-to-Face learning?  I am in Texas - we would probably have a civil war if this was required in schools, majority of parents would have a fit - its already bad enough with the mask requirements and heaven forbid a kid of one these vocal parents is quarantined - ugg.  

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

4 minutes ago, AdobeRN said:

Just curious how do the parents feel about all of this testing?  Is it a requirement for Face-to-Face learning?  I am in Texas - we would probably have a civil war if this was required in schools, majority of parents would have a fit - its already bad enough with the mask requirements and heaven forbid a kid of one these vocal parents is quarantined - ugg.  

Different states I think matter here. Again, I'm in MA. We are all about the masks, social distancing, COVID is real belief. It hit some of my families hard in the Spring and now it is hitting even more of my families hard. I've got several families with the entire family testing positive and/or in quarantine.

We require weekly surveillance testing if you want your student in person. But we are high needs students only right now and operating more a supervision model. The full remote model is very, very robust and available - I don't think we could require opting into testing if we do not have that option.

Parents actually really, really like that testing is done and available. Staff really like it. And while I spend so much time getting paperwork signed, overall, I've not had one family push back on me for it being required.

(Now when a student misses the testing day because of they didn't want to come to school that day, that is a challenge. I opt them out for the week, opt them back in on next test day. We do this so families realize how important being present on test day is. And also because if they don't want that spot, we have a waiting list of families that do.)

 

Edited by JenTheSchoolRN

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

3 hours ago, AdobeRN said:

Just curious how do the parents feel about all of this testing?  Is it a requirement for Face-to-Face learning?  I am in Texas - we would probably have a civil war if this was required in schools, majority of parents would have a fit - its already bad enough with the mask requirements and heaven forbid a kid of one these vocal parents is quarantined - ugg.  

We simply have too many schoolkids in Texas for this to be efficacious. IMO. But I agree - every year parents opt out of scoliosis screening (which is life-changing) and the 5th grade body development curriculum. I have no faith that a small vocal group of parents wouldn't get their way.

MHDNURSE, BSN, MSN, RN, NP

Specializes in Pediatrics, Community, and School Health. Has 21 years experience.

I'm in MA and we are doing Mirimus PCR pool testing. It has been working well, other than the fact that we can't make it mandatory so not everyone is taking advantage of it.  Wellesley Public schools started with it back in the Fall and I think we are the second district to use it. It is a saliva test.