key: cord-0691749-h2ha2efr
authors: Qian, Yan; Zeng, Tieying; Wang, Hui; Xu, Min; Chen, Junhua; Hu, Na; Chen, Daiqi; Liu, Yu
title: Safety management of nasopharyngeal specimen collection from suspected cases of coronavirus disease 2019()
date: 2020-04-04
journal: Int J Nurs Sci
DOI: 10.1016/j.ijnss.2020.03.012
sha: 57a0ff7c2bf332982cf810ac865d43c81d1035ac
doc_id: 691749
cord_uid: h2ha2efr

This article introduces safety management strategies of nasopharyngeal specimen collection from suspected cases of coronavirus disease 2019 in a tertiary designated hospital. The key points includes establishing a special sampling room, strict sterilization of the entire environment, training of professional nurses, enhancement of personal protection, standardization of methods and processes for swab collection, and a timely and safety sample submission. More than 11,000 nasopharyngeal specimens were collected by eight nurses, with an average of 1375 specimen swab collections each nurse, and no one was infected.

Nucleic acid examination is the gold standard for diagnosis of coronavirus disease 2019, and nasopharyngeal swab is the main method of sampling. During nasopharyngeal swab sampling, the medical staff has to be in close contact with the patient. The patient may cough, vomit, and breathe hard to produce a large number of droplets or aerosols, increasing the risk of cross-infection. In addition, the quality of nasopharyngeal swab collection is different due to the irregular operation and psychological fear of the collectors, which leads to false negative or false positive, which affects the judgment of the patient's condition.

Establishing a special room for nasopharyngeal swab sampling in the fever clinic of a designated hospital and conducting safety management strategies in aspects of specimen collection environment, collectors, sampling methods and specimen management have achieved effective results in reducing the infection risk of suspected cases and nursing staff, improving the standardization of biological specimen collection and ensuring the quality of specimens. 3 The causative pathogen of the coronavirus disease 2019 (COVID-19) is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early detection, diagnosis, treatment, and quarantine and isolation strategies of patients with COVID-19 can significantly prevent and control the transmission of the virus. By appropriately identifying the infected individuals and minimizing the transmission of the virus in the community, it is possible to effectively control the spread of infection. The early clinical symptoms of COVID-19 lack specificity, and its etiology is difficult to identify through computed tomography scans. Therefore, the handbook guide [1] suggests that the gold standard of diagnosing COVID-19 is real-time fluorescence-based real-time isolation rooms and install air purification systems. Therefore, our hospital designed and set up a special room under negative pressure for nasopharyngeal swab sampling, with an air change rate of 12 times per hour. To prevent close contact between suspected cases and the sampling collector, a transparent acrylic board with two openings for sampling was set up to separate the two areas for them ( Figure 1 ). The room was installed with air disinfectors and ultraviolet air purifiers.

Continuously running medical plasma air sterilizers and an ultraviolet light irradiation twice a day were both used. [7] . The nursing leads also received 5 training on operating standards of nasopharyngeal swab sampling, health education, matters needing attention, and measures in special circumstances. After theoretical learning, they received training on skills in self-protection and nasopharyngeal swab sampling. These nursing leads were required to pass an assessment with scenario simulation before they were able to begin working.

All nursing leads passed the assessment.

The 

The fever clinic collected 250 swab samples per day on average, with a peak of 300 samples.

To ensure the effectiveness of disinfection during sampling, shorten working time of nurses in the specimen collection room, concentrated collection method based on time intervals was conducted.

Two-hour rotation included one hour of sampling and one hour of disinfection was adopted. Two 6 nurses worked together in the two hours. A nurse collected nasopharyngeal swab samples, while another nurse explained relevant process and health education to the suspected cases waiting outside the sampling room. The concentrated collection method speeded sampling operation, and only 2-3 minutes was required for each sampling.

The novel coronavirus is highly contagious. Thus, nurses working in close contact with patients such as swab sampling are at a higher risk of infection. Nurses may experience anxiety and other negative emotions during the operation. Nursing administrators paid close attention to nurses' mental health and provided timely psychological support. All the eight sampling nurses were assigned based on voluntary. The nursing administrator participated in the task of nasopharyngeal swab sampling at the early stage. Importance of protection was strengthened and personal protection was double-checked before operating every time. Support and encouragement to swab sampling work and nurses were constantly. Online questionnaires for dynamic self-assessments and continuous support from a professional psychological counseling team were also provided to the nurses.

The suspected cases and their family were informed the process of swab sampling, possible adverse events and other important precautions, and a written informed consent from were required to sign by both of them before the sampling operation. was the patient and his or her family before collection. The suspected cases were told to avoid eating, drinking and aerosol inhalation and antibiotic treatment two hours before sampling operation. A video and a series of pictures showed the process of nasopharyngeal swab sampling and provided guide for suspected cases about how to properly cooperate during sampling. All the collected specimens should be placed in a double-layered bag with a clear bio-safety marking without delay, stored at 4℃ [6] and submitted to the laboratory within 2 hours. Medical waste produced during the collection process should be sealed in a double-layered yellow bag with a "special infection" label and delivered to the special medical waste temporary storage room.

An appropriate process for nasopharyngeal specimen collection from suspected cases of corona virus disease 2019 was developed following the principles of "early collection, sterile operation and low temperature storage" [6] . With the increase in numbers of suspected cases of COVID-19 and nucleic acid amplification test kits, the number of nasopharyngeal swab sampling continues to increase. From January 7, 2020 to February 16, 2020, over 11,000 nasopharyngeal swab samples were successfully collected at our hospital. Eight nurses operated over 1,375 times on average without any collector being infected. Through the establishment of the sampling room, 8 strict disinfection of the sampling environment, training of professional nurses, enhancement of personal protection, standardization of collection methods and processes, and timely and safe specimen transport, the goal of safety management was achieved. This is important and significant in ensuring the safety of healthcare professionals and improving the efficiency of nucleic acid amplification test for diagnosis of corona virus disease 2019.

National Administration of Traditional Chinese Medicine

The National Health Commission of the People's Republic of China: Corona Virus Disease 2019 Diagnosis and Treatment Plan (5th Trial Edition Revised Version)

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected

Manual for Prevention and Control of Novel Coronavirus Pneumonia (2020-01-28)

Investigation on implementing the Hospital Air Purification Management Standard WS/T368-2012

Global guidelines on the prevention of surgical site infection

National Health Commission of the People's Republic of China

National Health Commission of the People's Republic of China [Internet]．Guidelines on Use of Medical Protective Supplies in Prevention and Control of Novel Coronavirus Pneumonia (Trial Edition)

The author would like to thank all the participants in this study.

The authors have no conflicts of interest to declare.

None.

The study was conducted in accordance with the Declaration of Helsinki (2013) and approved by the Ethics Committee of the Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.