It is the policy of this facility to collect an upper respiratory specimen for SARS-CoV-2 screening and diagnostic testing in consultation with a healthcare provider consistent with State and Federal guidance.
Testing for SARS-CoV-2 (COVID-19), both diagnostic and screening based upon current State and Federal guidance, can detect current infection among residents and employees in order for prompt mitigation actions to be implemented in order to halt the transmission of COVID-19 in the facility.
*Consider working with local and state health departments to coordinate testing through public health laboratories or work with commercial or clinical laboratories using molecular and antigen tests.1
“Antigen POC tests: These diagnostic tests quickly detect fragments of proteins found on or within the virus by testing samples collected from the nasal cavity using swabs”2
Upper respiratory specimens are recommended for initial diagnostic testing. The type of specimen is based upon the test used and the manufacturer’s directions. Nasopharyngeal and oropharyngeal specimens are not appropriate for self-collection.
“Sterile swabs should be used for the collection of upper respiratory specimens. This is important to preserve both patient safety and specimen integrity.”1
“The following are acceptable specimens depending on the authorized SARS-CoV-2 viral test used:
- A nasopharyngeal (NP) specimen collected by trained healthcare personnel; or
- An oropharyngeal (OP) specimen collected by trained healthcare personnel; or
- A nasal mid-turbinate swab collected by trained healthcare personnel or by a supervised onsite self-collection (using a flocked tapered swab); or
- An anterior nares (nasal swab) specimen collected by trained healthcare personnel, or self-collected and observed by healthcare personnel, or by home or onsite self-collection (using a flocked or spun polyester swab); or
- Nasopharyngeal wash/aspirate or nasal wash/aspirate (NW) specimen collected by trained healthcare personnel; or
- A saliva specimen collected by the person being tested, either at home or at a testing site under supervision.”1
NOTE: Anterior nares (nasal swab) may be more acceptable to residents for testing
- Facemask or N95 Respirator
- Eye Protection (face shield, eye protection that cover sides)
- Sterile individually wrapped or bulk packaged swabs. Use only synthetic fiber swabs with plastic or wire shafts
- Do not use calcium alginate swabs or swabs with wooden shafts
- Sterile transport tube containing 2-3ml of either viral transport medium, Amies transport medium or sterile saline unless otherwise designated by lab
Procedure (If no specific Public Health directions are provided)1:
- Perform Hand Hygiene
- Gather Supplies
- Before engaging with residents, while donning a clean set of gloves, distribute individual swabs from the sterile bulk container into individual sterile disposable plastic bags.1
- Don PPE (gown, N-95 if available or facemask, eye protection, gloves)
- Close room door
- Limit only essential employees in room.
- Only grasp swab by the end of the handle with gloved hand
- Nasopharyngeal (NP) swab:
- Insert swab into nostril parallel to the palate until you reach resistance. The swab should reach depth equal to the distance from nostrils to outer opening of the ear.
- Roll the swab gently and leave the swab in place for several seconds to absorb secretions.
- Slowly remove swab while rotating the swab.
- It is acceptable, but not necessary, to collect specimens from both sides using same swab
- If a deviated septum or blockage is present, obtain specimen from the other nostril using the same swab
- Oropharyngeal (OP) (throat) swab:
- Swab the posterior pharynx, rubbing both tonsillar pillars
- Avoid touching the tongue, teeth or gums
- If both NP and OP swabs are collected, they should be combined in a single tube.
- Anterior nares
- Insert entire swab tip, usually ½ to ¾ inch inside nostril and firmly sample the nasal wall by rotating the swab in a circular motion at least 4 times for about 15 seconds
- Collect any nasal drainage present
- Sample both nostrils with same swab
- If employee or resident are self-collecting swabs under nurse supervision:
- Had resident a swab while wearing a clean set of gloves
- Instruct resident and observe self-swab
- Place swab in transport media or sterile transport device and seal
- Assist resident as needed
- Place swabs immediately into sterile tubes that contain 2-3 ml of viral transport media, Amies transport medium, or sterile saline, unless using a test designed to analyze a specimen directly (i.e. point of care testing)4
- For Point-of-Care Testing onsite:
- Gloves should be changed between specimen collection and after adding the specimen to the testing device
- Follow manufacturer’s directions for testing
- Disinfect testing device in accordance with manufacturer’s instructions
- Remove PPE in proper sequence
- Perform Hand Hygiene
- Label Specimen
- Specimen can be stored at 2-8°C for up to 72 hours after collection.
- Disinfect room and surfaces with EPA list N disinfectant.
Note: If sending specimen to CDC, follow instructions at: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
- Label specimen with the resident’s ID number (i.e. medical record number), unique CDC or state-generated NCov specimen ID
- Complete Specimen Submission form: https://www.cdc.gov/laboratory/specimen-submission/form.html and https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19-Specimen-Submission-Guidance.pdf
- If shipping to CDC, follow Public Health directions according to the current edition of the International Air Transport Association (IATA) Dangerous Goods Requirements.https://www.iata.org/en/programs/cargo/dgr/
- If there is a delay in shipping, store specimens at -70°C or below.
- Follow Public Health directions for shipping instructions
References and Resources
1Centers for Disease Control and Prevention (CDC). Interim Guidelines for Collecting, Handling and Testing Clinical Specimens for COVID-19 Updated Dec. 21, 2020: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
Centers for Disease Control and Prevention: Testing Guidelines for Nursing Homes. Updated Oct. 16, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html
Centers for Disease Control and Prevention (CDC). Interim Infection and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19 Pandemic. Updated Dec. 14, 2020: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
2Office of the Assistant Secretary for Health (OASH), HHS.gov. SARS-CoV-2 (COVID-19) Fact Sheet. Guidance – Proposed use of Point-of-Care (POC) Testing Platforms for SARS-CoV-2 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/downloads/OASH-COVID-19-guidance-testing-platforms.pdf