Respiratory surveillance through point of care molecular testing and its impacts on nursing home RSV, influenza, and SARS-CoV-2 awareness and reporting behavior: a pilot study.

Objectives: To evaluate feasibility of establishing syndromic respiratory virus surveillance in a network of U.S. nursing homes, using CLIA-waived point-of-care (POC) molecular PCR testing, with centrally delivered results. Design: Single-arm feasibility pilot study. Setting and Participants: Twenty-three nursing homes (NHs) in six U.S. states, representing approximately 2,500 residents. Methods: A CLIA-waived POC molecular PCR testing device was implemented for on-site testing of respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and influenza A and B from collected nasal swabs. Symptom data was entered at the time of testing. Test results were transmitted to a centralized, web-based dashboard providing near real-time surveillance from November 2023 to January 2025. Surveys of NH staff assessed device usability, workflow integration, impact on testing procedures, and infection and outbreak awareness. Results: The established syndromic respiratory virus surveillance network conducted 1,745 point-of-care tests between November 2023 and January 2025, identifying 360 infections, including 160 COVID-19, 115 influenza A and B, and 81 RSV infections. Symptom data was captured for 99.5% of tests. Implementation was associated with high data completeness and integration into facility testing workflows. Staff reported an impact on testing protocols, infection awareness, and time to diagnosis. Conclusions: Implementation of a CLIA-waived POC molecular testing device with centralized reporting was feasible across a geographically diverse NH network. The system achieved high data capture, identified substantial viral activity, and demonstrated value for clinical management using real-time diagnostic results. This approach can be adapted for local, regional, or national real-time reporting or future pragmatic interventional studies.