Universal Pre-procedural Screening for COVID-19 with RT-PCR for SARS-CoV-2 during the First Wave of Pandemic Period in King Chulalongkorn Memorial Hospital

Main Article Content

Sunisa Sangtongjaraskul


pandemic was the global health crisis. Institutional protocol
for pre-procedural screening with real-time reverse
transcription polymerase chain reaction (RT-PCR) was
applied since increasing cases in Thailand.
Objectives of Study: To evaluate the prevalence of
positive pre-procedural RT-PCR test for COVID-19 and its
effect on pre-operative waiting time.
Materials and Methods: Observational study in university
hospital was performed since 13 April to 31 May 2020.
Every patient scheduled for aerosol-generating procedures
were enrolled. Patients were pre-operatively screened for
COVID-19 by RT-PCR with specimen from nasopharyngeal
and/or throat swabs. Risk factors, clinical symptoms and
chest radiograph were collected. Pre-operative waiting
time was also recorded.
Results: One thousand and two hundred patients were
enrolled (89.66% inpatient cases and 12.17% emergencycases). No patients had positive RT-PCR test. Most
common risk factors were history of visiting crowded area.
Fever and cough were suspected symptoms recorded.
None of healthcare providers found positive for COVID-19
in this study. Furthermore, no abnormal chest radiography
related to COVID-19 detected. Pre-operative waiting time
was minimally delayed for urgency procedures with
approximately 177 minutes from scheduling to starting
operations compared with 144 minutes in normal situation.
Conclusion: Despite of negative result, appropriate
protocols to control disease transmission are important.
Cost-effectiveness and patients’ inconvenience should be
considered. Protective equipment should be available if
COVID-19 screening was not performed.


Article Details

Original articles


1. World Health Organization. WHO Director-General’s opening
remarks at the media briefing on COVID19 [Internet]. 25 March
2020 [cited May 20, 2020]. Available from: https://www.who.
2. Cucinotta D, Vanelli M. WHO declares COVID-19 a
pandemic. Acta Biomed 2020;91:157-60.
3. Kiatkasemsan B, Chaichalothorn M, Payongsri T,
Charuluxananan S. Outbreak of novel coronavirus (2019-
nCoV): The first three-month experience of anesthesiologists
in Thai university hospital. Chula Med J 2020;64;231-6.
4. Center of Disease Control (CDC). Interim guidelines for
collecting, handling, and testing clinical specimens from
persons under investigation (PUIs) for coronavirus disease
2019 (COVID-19) [Internet]. February 14, 2020 [cited March
20, 2020]. Available from: https://www.cdc.gov/coronavirus/
5. Al-Muharraqi MA. Testing recommendation for COVID-19
(SARS-CoV-2) in patients planned for surgery- continuing
the service and ‘suppressing’ the pandemic. Br J Oral
Maxillofac Surg 2020. doi.org/10.1016/j.bjoms.2020.04.014
6. American College of Surgeons, American Society of
Anesthesiologists, Association of perioperative Registered
Nurses, American Hospital Association. Joint Statement:
Roadmap for resuming elective surgery after COVID-19
pandemic [Internet]. April 17, 2020 [cited May 20, 2020].
Available from: https://www.asahq.org/about-asa/newsroom/
7. Urban MJ, Patel TR, Raad R, et al. Implementation of
preoperative screening protocols in otolaryngology during
the COVID-19 pandemic. Otolaryng Head Neck 2020. doi.
8. Desmond S, Karin F, Mary DA, Dena G. Universal screening
for SARS-CoV-2 in women admitted for delivery. N Engl J
Med 2020. doi: 10.1056/NEJMc2009316
9. Noelle B, Caitlin B, Cynthia GB, et al. COVID-19 infection
among asymptomatic and symptomatic pregnant women:
Two weeks of confirmed presentations to an affiliated pair of
New York City Hospitals. Am J Obstet Gynecol 2020. doi.
10. Society of American Gastrointestinal and Endoscopic
Surgeons and European Association for Endoscopic
Surgery. SAGES and EAES recommendations regarding
surgical response to covid-19 crisis [Internet]. March 30,
2020 [cited May 20, 2020]. Available from: https://www.
11. Department of medical services, Ministry of Public Health,
Thailand. Protocol for procedures/operations in COVID-19
pandemics [Internet]. May 7, 2020 [cited May 20, 2020].
Available from: http://covid19.dms.go.th/
12. Ministry of Public Health, Thailand. COVID-19 infected
situation reports in Thailand. [internet]. 2020 [cited 2020 May
31]. Available from: https://covid19.ddc.moph.go.th/en
13. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-
nCoV infection from an asymptomatic contact in Germany.
N Engl J Med 2020; 382: 970-1.
14. Moriarty LF, Plucinski MM, Marston BJ, et al. Public health
responses to COVID-19 outbreak on cruise ships-Worldwide,
February-March 2020. MMWR 69, 347-52. doi.org/10.15585/
15. Marie FRO, Jubilee B, Mauricio SA, et ac. Surgical and
clinical reactivation for elective procedures during the
COVID era: a global perspective. J Minim Invasive Gynecol
2020 doi.org/10.1016/j.jmig.2020.05.012
16. Howard BE. High-risk Aerosol-generating procedures in
COVID-19: respiratory protective equipment considerations.
Otolaryng Head Neck 2020. doi.org/10.1177/0194599820
17. Zheng L, Yawei Z, Xishan W, et al. Recommendations for
surgery during the novel Coronavirus (COVID-19) epidemic.
Indian J Surg 2020. doi.org/10.1007/s12262-020-02173-3.
18. Carl H, Jason O, Tom J. COVID-19 how many healthcare
workers are infected? The centre for evidence-based
medicine develops, promotes and disseminates better
evidence of healthcare [internet]. 2020 [cited 2020 April 17]
Available from: https://www.cebm.net/covid-19/covid-
19. World Health Organization Thailand. COVID-19 infected
situation reports in Thailand. [internet]. 2020 [cited 2020 April
13] Available from: https://www.who.int/docs/default-source/
20. Lei S, Jiang F, Su W, et al. Clinical characteristics and
outcomes of patients undergoing surgeries during the
incubation period of COVID-19 infection. EclinicalMedicine
2020. doi.org/10.1016/j.eclinm.2020.100331
21. The New South Wales Government. COVID-19 testing before
surgery [internet]. 2020 [cited 2020 April 21] Available from:
22. American Society of Anesthesiologists and Anesthesia
Patient Safety Foundation. The ASA and APSF Joint Statement
on Perioperative Testing for the COVID-19 Virus [internet].
2020 [cited 2020 April 29]. Available from: https://www.
23. Paul W, Robert SP, Mahan G, José L. Estimating falsenegative
detection rate of SARS-CoV-2 by RT-PCR [Internet].
14 April 2020 [cited 2020 April 29]. Available from: https://
24. Winichakoon P, Chaiwarith R, Liwsrisakun C, et al. Negative
nasopharyngeal and oropharyngeal swab does not rule out
COVID-19. J Clin Microbilo 2020. doi:10.1128/JCM.00297-20
25. Wong HY, Lam HY, Fong AH, et al. Frequency and distribution
of chest radiographic findings in COVID-19 positive patients.
Radiology 2020. doi.org/10.1148/radiol.2020201160
26. World Health Organization. Advice on the use of point-of-care
immunodiagnostic tests for COVID-19 [Internet]. 9 April 2020
[cited 2020 April 29]. available from: https://www.who.int/
27. Royal Australasian College of Surgeons. Guidelines for
safe surgery: open versus laparoscopic: A rapid review
commissioned by RACS [internet]. 2020 [cited 2020 May
25]. available from: https://umbraco.surgeons.org/media/
28. Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative
COVID-19 defense: An evidence-based approach for
optimization of infection control and operating room
management. Anesth Analg 2020. doi.org/10.1213/ane.0000