A cluster-randomized trial found that point-of-care respiratory virus testing in nursing homes reduced the likelihood of emergency department (ED) transfers during outbreaks of SARS-CoV-2, influenza, or RSV.1
“When a nursing home resident has to transfer to the hospital, it’s an event,” said Robin L.P. Jump, MD, PhD, Associate Professor of Medicine at the University of Pittsburgh School of Medicine. “It usually means a ride in an ambulance. It means going to the emergency room. It’s noisy. It’s disorienting… And for someone who’s frail and maybe has dementia, it can be really hard to withstand. Point-of-care testing for respiratory viruses in the nursing home lessens the time to diagnosis and enables earlier implementation of infection prevention and control measures.”
The study, published in JAMA Internal Medicine, assessed the effect of an onsite, point-of-care respiratory multiplex polymerase chain reaction (POC-RM-PCR) instrument on outbreaks of the aforementioned viruses in nursing homes. The study was conducted in 20 nursing homes with 3,963 beds in Toronto, Ontario, between November 12, 2024, and May 2, 2025. Participating homes were randomized 1:1 to either use of a POC-RM-PCR instrument or standard of care based on their crowding index, which involved transferring respiratory specimens to a local reference microbiology laboratory for testing.1
The primary outcome was the combined outbreak number and size of key respiratory pathogens, including SARS-CoV-2, influenza, and RSV. Secondary outcomes included the rates of resident ED transfer and death.
“The tricky part with the primary outcome was that the intervention led to increased testing, and increased testing leads to increased detection,” said lead author Christopher Kandel, MD, PhD, Infectious Disease Specialist at Michael Garron Hospital and Assistant Professor at the University of Toronto. He added, “Overall, results indicated that the number of outbreaks and the outbreak size wasn’t different. Putting the platform in the long-term care home increased the total number of tests that were collected, improved time to antiviral administration, and it may have reduced the number of hospital transfers.”
Specifically, use of POC-RM-PCR resulted in an 11% absolute reduction in the probability of ED transfer during an outbreak.
Dr. Kandel also noted that placing POC instruments in long-term care homes was relatively easy, saw high uptake, and clearly led to process changes within those homes. However, it is unclear how these results will translate to the real world, where nursing homes must pay for testing.
Additionally, further research is needed across a wider range of nursing home locations and acuity levels to assess the impact of the intervention and whether the benefits can be sustained over time. For example, POC testing may have a greater effect in rural nursing homes, where turnaround time for send-out tests tends to be longer.
“The next step with any sort of intervention like this is trying to assess the sustainability of the impact,” Dr. Kandel said. “So the next step is to evaluate the impact of the control homes moving to intervention and using the platform in year two and then compare that with the homes that were in the intervention for a second year. We’re also hoping to study whether we can improve all outbreak metrics, including time to receive antivirals, time to chemoprophylaxis, and outbreak size.”
References
1. Kandel C, Oriotis D, Candon HL, et al. Respiratory outbreak mitigation with point-of-care testing in long-term care: a randomized clinical trial. JAMA Intern Med. 2026;186(9):1114–1121. doi:10.1001/jamainternmed.2026.2644
