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Nasopharyngeal Testing

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Last Updated: 02 July 2021

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General | Latest Info

Nasopharyngeal swabs are specifically manufactured to have long, flexible shafts made of plastic or metal and tips made of polyester, rayon, or flock nylon. In addition to nasopharyngeal swabs, you will need personal protective equipment, including a gown, nonsterile gloves, protective mask, and face shield, as described below. Make sure that all sample tubes have been labelled and that appropriate requisition forms have been filled out before starting procedure. It is essential that you follow pertinent respiratory and contact precautions specified by the Centers for Disease Control and Prevention and by your own institution and that you put on PPE correctly. If possible, you should put on and take off PPE in presence of an observer to make sure there are no breaks in technique that may pose risk of contamination. First, put on a protective gown, wash your hands with soap and water, and put on a pair of nonsterile gloves. Then put on protective mask with a rating of N95 or higher, as recommended by CDC. Finally, put on face shield for face and eye protection. Masks are recommended for all patients suspected of having COVID - 19. Ask patient to take off her mask and blow her nose into tissue to clear excess secretions from nasal passages. Remove swab from packaging. Tilt patients head back slightly, so that nasal passages become more accessible. Ask the patient to close her eyes to lessen mild discomfort of procedure. Gently insert swab along the nasal septum, just above the floor of nasal passage, to the nasopharynx, until resistance is felt. Insert swab into nostril, parallel to palate. If you detect resistance to passage of swab, back off and try reinserting it at a different angle, closer to the floor of the nasal canal. Swab should reach a depth equal to the distance from nostrils to outer opening of ear. Cdc recommends leaving swab in place for several seconds to absorb secretions and then slowly removing swab while rotating it. Your institution may also recommend rotating swab in place several times before removing it. Ask the patient to reapply her mask. Open collection tube and insert swab into the tube. Break swab at groove and discard what remains of swab. Close labeled collection tube, wipe tube with surface - disinfectant wipe, and insert tube into open biohazard bag held by assistant. Depending on institutional practices, you may instead return the sample to its original packaging for transport. Follow CDC directions for direct processing of swab specimen or placement of swab in media with or without refrigeration.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

To the Editor:

Table

AuthorAffiliation
Tony Zitek, MDKendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida; Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida

At this time, no peer - review publications have reported the sensitivity and specificity of RT - PCR tests for COVID - 19. One non - peer review publication reports that, based on 87 Chinese patients who were ultimately diagnosed with COVID - 19, pharyngeal RT - PCR tests have a sensitivity and specificity of 78. 2% and 98. 8%, respectively. 8 sensitivity was 62. 5% for mild cases. 8 While no other publications currently provide estimates of sensitivity and specificity, several peer - review publications have provided evidence of substantial false negative rate with RT - PCR swab tests as described below. First, study by Wang et al took various types of specimens from 205 patients with confirmed COVID - 19 and tested them with RT - PCR. Of 398 pharyngeal swabs, they found only 126 were positive. They took just eight nasal swabs, and found five were positive. 9 Wang et al also analyzed specimens from bronchoalveolar lavage fluid and sputum and found these were positive in 93% and 72% of cases, respectively. 9 along same lines, Winichakoon et al published a letter to editor in which they described the case of a COVID - 19 patient who had nasopharygeal / oropharyngeal RT - PCR swab that was negative for COVID - 19, but RT - PCR of BAL fluid was positive. 11 Additionally, 19 cases of patients with suspected COVID - 19 were reviewed in another small study. Oropharyngeal RT - PCR swab tests were performed in all 19 patients, but were positive in just nine. 12 next, in the case series described by Xie et al, five patients from Hunan Province of China had grind - glass opacities on chest compute tomography that were suggestive of COVID - 19, but initial pharyngeal RT - PCR tests were negative. Repeat RT - PCR swabs end up being positive. 13 Similarly, Fang et al analyzed 51 patients who were ultimately confirmed to have COVID - 19 who had both chest CT and RT - PCR testing by either throat swab or sputum upon admission to hospital. Of those 51 patients, chest CTs had characteristic findings of COVID - 19 in 50. Comparatively, initial RT - PCR test was positive in 36 of 51. 14 other studies have also demonstrated that initial RT - PCR tests may be negative and then become positive with repeated tests. For example, Wu et al studied clinical courses of 80 patients from Jiangsu Province who were ultimately diagnosed with COVID - 19. Nine of those 80 patients had two negative RT - PCR nasal or oral swabs before their third swab came back positive. 15 Additionally, Young et al report results from daily nasopharyngeal RT - PCR testing that was taken from 18 patients from Singapore who were hospitalized for COVID - 19. Interestingly, some patients had positive tests, and then negative tests, and then positive tests again, all within the same hospitalization.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

3. The nasopharyngeal swab

Nasopharyngeal swabs and their ability to collect mucus and saliva and release them into transport medium with a high recovery rate are of paramount importance in detection of bacterial and viral infections. The US FDA and CDC recommend polyurethane foam swabs for PCR detection of most respiratory viruses including SARS - CoV - 2, rhinoviruses and enteroviruses, influenza viruses, parainfluenza, metapneumoviruses and respiratory syncytial viruses, coronaviruses and bacterial infections caused by Streptococcus pneumoniae and Streptococcus pyogenes. Foamtec Medical Nasopharyngeal swabs utilize Foamtec develop polyurethane foam technology that provides exceptional surface area to capture maximum quantity of target fluids, while not bonding to those fluids providing high subject recovery. Foamtec Medical proprietary swab cleaning processes and validated sterility ensure no background from RNAse and other contaminants for accurate test results. While providing precise results, comfort in Nasopharyngeal swabbing is achieved with long, slender, flexible handles keeping patient discomfort to a minimum while reaching remote areas of nasal septum and oral cavities.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

5. Discussion

Home self - collect midnasal swab Ct values were positively associated with paired clinician - collect nasopharyngeal swab Ct value. Ct values were calculated from severe acute respiratory syndrome Coronavirus 2 Reverse Transcriptase - Polymerase Chain Reaction assay that targets 2 distinct regions of virus, using Centers for Disease Control and Prevention primers and probes for virus nucleocapsid gene, N1 and N2. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years, including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents plan, pending, or issue. If you have no conflicts of interest, check no potential conflicts of interest in the box below. Information will be posted with your response. Not all submitted comments are publish. Please see our commenting policy for details.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Saliva

One thing has become apparent in the ongoing pandemic of COVID - 19. Early diagnosis and treatment, when necessary, is crucial to prevent progression of disease to critical and life - threatening stages where the mortality rate is much higher than otherwise. Rapid diagnosis is also key to containing outbreaks by allowing for efficient contact tracing in hospitals as well as in communities. A new study on preprint server medRxiv * in May 2020 compared the reliability of testing results obtained from Saliva vs Nasopharyngeal swabs, suggesting the feasibility of relying on the former as a quicker and easier way of obtaining test specimens with lower risk of exposure and less need for training and protective equipment. The Rationale for using NPS specimens for diagnosis of COVID - 19 by RT - PCR is abundance of angiotensin - converting enzyme 2 receptors in the upper respiratory tract. However, ACE2 is also found at high levels in the tongue, which explains why the mouth is a prime site for infection with viruses how Saliva can pass on infection even before symptoms appear, and the occurrence of ageusia. This indicates a high possibility of using Saliva for diagnosis of COVID - 19, with even better sensitivity than NPS. The current study aims at exploring the diagnostic value of two sample types in a prospectively designed manner.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

How is the test done?

Cdc recommends COVID - 19 test called nasopharyngeal swab fo coronavirus. A technician will put a special 6 - inch cotton swab up both sides of your nose and move it around for about 15 seconds. It wonat hurt, but it might be uncomfortable. Theyall send swab to the lab to test material from inside your nose. Your mouth and throat middle of your nostrils in front of your nostrils If you have cough with mucus, called aweta or aproductivea cough, your doctor might want to test some of what you can cough up. Each state has one or more public health labs that do testing. That number is growing. For information about testing in your state, check onlineA at CDC. Fda has issued an emergency use ruling for LabCorpas Pixel home COVID - 19 test. That means you can use it even though it does have full FDA approval yet. This test has a special cotton swab that you run inside your nose, like a technician would, and mail to the lab for analysis. The agency is also allowing use of home saliva test from Rutgers Clinical Genomics Laboratory. You need a doctoras prescription to get it. You spit into a vial and mail it to the lab. Agencys have taken similar steps with blood or aserologya tests that can look for antibodies. Your body makes them when you have had an infection. Igm, which your body makes for about 2 weeks before levels drop IgG, which your body makes more slowly but which usually lasts longer swab or spit test can tell only if you have a virus in your body at that moment. But blood test shows whether you have ever been infected with the virus, even if you didnat have symptoms. This is important in researchersa efforts to learn how widespread COVID - 19 is.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

LETTER

Nejm publication expands on work previously reported by Wyllie and colleagues in April preprint article posted to site MedRxiv. These findings represent an important advance in testing for COVID - 19, Jason Farley, PhD, MPH, of Johns Hopkins Schools of Nursing and Medicine, Baltimore, Maryland, told Medscape Medical News. An Infectious disease - trained nurse epidemiologist, Farley was not involved in Yale team work, but he has worked on efforts at Hopkins to test individuals using saliva samples to track COVID - 19 infection. The pragmatic approach used by the Yale team avoids the kind of issues with shortages of medical supplies that have hampered US testing, Farley say. Their approach relies on supplies hospital laboratories are likely to have on hand. A letter in NEJM, for example, says sterile urine cups were used to gather samples. This move US forward, especially with supply - chain issues, he said of the new research. Wyllie and Nathan Grubaugh, PhD, of Yale School of Public Health, last month secured emergency use authorization from the US Food and Drug Administration for a related test protocol, called SalivaDirect. This is a simplified version of the test described in the NEJM letter, with researchers having eliminated the RNA extraction step. The FDA said this was the fifth test it had authorized to use saliva as a sample for testing for COVID - 19. But Yale's approach with SalivaDirect is markedly different from that used by many Diagnostics, as webpage for test notes. The common question that we receive is what company is behind this assay? The answer is, well, there isn't one. We design and validate SalivaDirect using several common and available reagents. If one reagent is out of stock or is too pricey, there are alternative reagents to use, say backgrounder on CovidTrackerCT website, created by members of Grubaugh's lab. Salivadirect is protocol, not kit, which is intended to help other medical institutions also do inexpensive saliva - base testing, backgrounder say. I love the fact that they are sharing their protocols in an open - source way so that people can replicate protocol,s Farley say. The Yale team really needs to be commended for that level of scientific integrity. Also enthusiastic about this protocol is Andy Slavitt, WHO was administrator of Centers for Medicare & Medicaid Services in the Obama Administration. In a series of tweets on August 15, Slavitt said Yale team is turning testing from bespoke suits to low - cost commodity. Salivadirect should create millions more in test capacity. Easy to use. High volume. Cheap. Widely available and accurate, he tweet. The University of Illinois, Urbana - Champaign, already has use FDA's emergency use authorization for Yale's protocol as a path for using its own saliva testing at school. Researchers performed what's called bridging study that put their project under the umbrella of FDA's emergency approval of Yale test.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Diagnostic specimens

Proper collection of specimens is the most important step in laboratory diagnosis of infectious disease. Specimens that are not collected correctly may lead to false negative test results. Cdc list following specimens acceptable for diagnostic testing for SARS - CoV - 2. Nasopharyngeal collected by Healthcare Professional Oropharyngeal collected by Healthcare Professional Nasal Mid - turbinate collected by Healthcare Professional or supervise onsite self - collection anterior nares collected by Healthcare Professional or self - collection onsite or home nasopharyngeal wash / aspirate or Nasal wash / aspirate collected by Healthcare Professional All swab specimens should be place immediately in sterile Transport tube containing viral Transport medium, Amies Transport medium or sterile saline, unless using POC test system which analyze Specimen directly. When collecting diagnostic respiratory specimens from patients with possible COVID - 19, following should occur: Specimen collection should be performed in a normal examination room with door close, if possible. Healthcare professionals collecting samples should wear N95, eye protection, gloves, and gown. Healthcare professionals assisting but not directly involved in collection and able to maintain 6 feet from patient should wear a face mask, eye protection, gloves and a gown. If N95 is not readily available, wear a facemask. N95 may be prioritize for other procedures at higher risk for producing infectious aerosols, instead of for collecting nasopharyngeal swabs. The number of healthcare professionals present during procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for Specimen collection. Clean and disinfect procedure room surfaces promptly. For handling and testing clinical specimens, use standard precautions to provide barrier between Specimen and HCP during Specimen manipulation. Require PPE include: eye protection & / or splash guard gloves, laboratory coats or gowns. Do not wear lab coat or gown outside of the testing area. Hand hygiene employers should select the appropriate PPE and provide it to HCP in accordance with OSHA PPE standards. Hcp must receive training on and demonstrate understanding of: when to use PPE, what PPE is necessary, how to properly don, use, and doff PPE in a manner to prevent self - contamination, how to properly dispose of or disinfect and maintain PPE limitations of PPE. Any reusable PPE must be properly clean, decontaminate, and maintained after and between uses. Facilities should have policies and procedures describing recommended sequences for safely donning and doffing PPE. If you are sending specimens directly to CDC or state Health laboratory, check with your local Health Department for guidance on transporting and shipping of infectious substances. Most health departments have processes established to ship specimens to state labs or CDC. Suspect COVID - 19 specimens must be transported according to International Air Transport Association guidelines for Infectious substances, category B. Primary receptacle Secondary packaging Rigid outer packaging, labelled with UN3373 label. See CDC packaging schema diagram and IATA packing instructions 650 for UN 3373. Click on Infectious substances and download packing instructions. Requisition for submitting specimens to CDC for lab testing form must be completed electronically to use drop downs. Review guidance for completing form.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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