At least two Selangor public hospitals are making Covid-19 tests mandatory for those to be admitted after infections were detected among staff and patients, hospital sources said.
Selangor public hospitals are seemingly catching up to the ones in Sabah, which have mandated pre-admission Covid-19 screening for several months now, following the outbreak there in September.
While the Health Ministry has a Covid-19 testing guideline for certain medical treatment or hospital transfers, the standard operating procedure for other admissions vary from hospital to hospital, Malaysiakini learnt.
In Tengku Ampuan Rahimah Hospital (HTAR), Klang, where more than 50 staff members and patients were infected in the past three weeks, mandatory pre-admission tests were imposed last week.
Before that, the hospital screened patients being admitted using a questionnaire, with only those deemed high risk or symptomatic tested for Covid-19.
This is according to Health Ministry sources who spoke on condition of anonymity as civil servants cannot speak to the media without authorisation.
Those who are being transferred from other hospitals or seeking certain medical procedures have to undergo Covid-19 testing, but most patients admitted do not get tested.
This included those who were admitted after arriving at the emergency department, it is learnt.
'Ground staff doing their best, but more resources needed'
The admissions procedure in HTAR changed following the outbreak, with all patients now subjected to at least testing using antigen rapid test kits (RTK Antigen) pre-admission, sources familiar with the new guidelines told Malaysiakini.
RTK Antigen tests are favoured in mass testing as it produces results within a short period of time, often in less then one hour, but it is less sensitive and more prone to false negatives, especially if the virus is still in the incubation period.
This means patients who are infected may test negative using the RTK Antigen test, only to later develop symptoms and test positive for Covid-19 after spending time in the wards.
Polymerase chain reaction (PCR) testing is considered the gold standard in terms of sensitivity and accuracy but is more labour intensive, requires laboratory resources and takes longer to produce results.
For hospitals like HTAR, which has more than 1,000 beds, subjecting all patients to PCR tests would place an enormous burden on the hospital laboratory.
It is learnt Covid-19 testing was not done on all admitted patients before this due to lack of resources, especially in the laboratories.
“I certainly think the lab staff are killing themselves to process the tests. The staff on the ground are doing their best, but more resources need to be allocated,” one hospital source said.
Meanwhile, a source at Serdang Hospital said it is now "scrambling" to impose mandatory pre-admission tests after at least a dozen cases were detected among staff and patients in the past fortnight.
Like in HTAR, previously only those symptomatic and considered high risk were tested before admission.
In contrast, public hospitals in Sabah have imposed mandatory pre-admission Covid-19 tests for all patients.
Patients are subjected to an RTK Antigen test right before admission, and those who test positive are directly transferred to a Covid-19 hospital or ward.
Those who test negative are admitted into non-Covid-19 wards but will further be given a PCR test. If their PCR test is positive, they are sent to a Covid-19 hospital or ward, a source familiar with the procedures told Malaysiakini.
In Sabah, PCR test results take 12 to 24 hours.
'Caretakers bring virus into wards'
Even with such testing, Covid-19 still finds its way into hospital wards via caretakers, sources said.
Hospitals usually allow caretakers to stay in the wards with patients, as it could help alleviate the burden on nurses.
But caretakers are not screened for Covid-19 before being allowed in, it is learnt.
It is understood that following some infections involving caretakers, some hospitals have insisted that they undergo Covid-19 PCR testing before they are allowed to care for patients in the wards.
Sabah infections spiked in September following the state elections, but cases have progressively decreased since then.
It recorded 4,246 new cases in the past fortnight, while Selangor, the new epicentre of the outbreak, recorded 7,363 cases in the past 14 days.
The Klang district, where HTAR is located, is the worst-hit with 3,482 cases in the past fortnight while Sepang, where Serdang Hospital is located, recorded 164 cases in the same period.