Key Takeaways: 

• A retrospective study of nearly 1.8 million admissions across 120 Department of Veterans Affairs (VA) facilities found that inpatient SARS-CoV-2 testing policies were associated with lower rates of hospital-onset COVID-19.
• The absence of an admission testing policy was associated with increased odds of hospital-onset infection in 2020 (odds ratio [OR], 5.9) and 2021 through 2023 (OR, 3.2), but not in 2024.
• Admission testing was associated with reduced hospital-onset COVID-19 when admission positivity was below 10%, suggesting that testing effectiveness may depend on the level of circulating infection.

Hospital admission testing policies for SARS-CoV-2 were associated with reduced hospital-onset COVID-19 infections, particularly during periods of lower admission positivity, according to research presented at IDWeek 2026.

The findings highlight the potential role of targeted respiratory virus screening in infection prevention strategies, with implications for protecting vulnerable patients in hospitals and long-term care settings.

Evaluating Admission Testing Across VA Facilities

Researchers conducted a retrospective cohort study examining 1 786 773 admissions across 120 VA facilities between January 2020 and December 2024.

The analysis divided the study period into 3 intervals: 2020, 2021 through 2023, and 2024.

An active admission testing policy was defined as testing at least 75% of admitted patients within 24 hours before or after admission. Hospital-onset COVID-19 was identified through new positive SARS-CoV-2 tests occurring more than 48 hours after admission.

Overall, 83% of admissions occurred at facilities with an active testing policy, and 14 251 hospital-onset infections were identified.

Testing Effectiveness Varied by Pandemic Period

After adjustment for patient and facility characteristics, the absence of an admission testing policy was associated with significantly greater odds of hospital-onset COVID-19 in 2020 (OR, 5.9; 95% CI, 3.0-13.0) and 2021 through 2023 (OR, 3.2; 95% CI, 1.6-6.4).

However, this association was not significant in 2024 (OR, 0.84; 95% CI, 0.46-1.55).

Further analysis found that admission testing was associated with reduced hospital-onset infections when admission positivity was below 10%, with estimated absolute reductions of 0.3 to 0.7 percentage points. No comparable benefit was observed at higher positivity levels.

Implications for Long-Term Care

Although the study focused on VA hospitals rather than long-term care facilities, its findings may inform discussions about respiratory infection prevention in settings serving medically vulnerable older adults.

The researchers suggested that the limited effectiveness of admission testing during periods of high positivity could reflect infections introduced through sources other than newly admitted patients.

These findings underscore the importance of considering community transmission levels and multiple potential sources of infection when developing screening policies.

The observational design does not establish causation, and additional research is needed to determine whether similar testing strategies would reduce transmission in nursing homes and other long-term care facilities.

Overall, the findings suggest that admission testing may be a useful component of broader infection prevention efforts, particularly during periods of lower SARS-CoV-2 positivity.

Reference 

Karten J, Feldman T, Jackson N, et al. Impact of inpatient SARS-CoV-2 virus testing policy on healthcare-associated respiratory virus transmission across the VA healthcare system. Poster presented at: IDWeek 2026. October 21-24, 2026. Washington, DC. P-2123. Accessed October 29, 2026. https://idweek2026.eventscribe.net/fsPopup.asp?PosterID=838086&mode=posterInfo