Accuracy of Healthcare Professionals’ Nasopharyngeal Swab Technique in SARS-CoV-2 Specimen Collection

  1. Robbie S. R. Woods
  2. Kellie Nwaokorie
  3. Jana Crowley
  4. Michael Walsh
  5. Eoghan de Barra
  6. Peter D. Lacy

Reviewed by

Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

Background

The COVID-19 pandemic has caused huge pressure on healthcare systems worldwide. Public health measures to control the virus are reliant on testing, including appropriate collection of specimens for analysis.

Methods

A prospective study of nasopharyngeal swab technique by staff in an academic tertiary referral centre was carried out. Nasopharyngeal swab technique was evaluated by a novel design of a navigated swab on a three-dimensional model head.

Results

Swab technique of 228 participants was assessed. Technique was poor, with a success rate of nasopharyngeal swabbing at 38.6%. Angle and length of insertion were significantly different between those with successful and unsuccessful technique. Doctors were significantly more accurate than nurses and non-healthcare professionals (p<0.01).

Conclusion

Inaccurate specimen collection from poor swab technique could contribute to a false negative rate of testing for SARS-CoV-2. Specific training in nasopharyngeal anatomy and swab technique may improve the accuracy of nasopharyngeal swabbing.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.10.19.20213140: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All healthcare staff at the institution were invited to participate and informed consent for participation was obtained.
    IRB: The study was approved by the hospital ethics committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    A navigated swab was created by inserting a tip-tracked electromagnetic navigable stylet (Medtronic, Minneapolis, MN, USA) into a standard nasopharyngeal culture swab and securing it in position with glue, as shown in Figure 2.
    Medtronic
    suggested: (Medtronic, RRID:SCR_003988)
    ImageJ software (National Institutes of Health, Maryland, United States) was used to analyse swab position.
    ImageJ
    suggested: (ImageJ, RRID:SCR_003070)
    Statistical analysis was performed using IBM SPSS Statistics version 23.0.0.2 software (IBMCorp. NewYork, United States).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are some limitations in this study. The technique evaluated considered swab position but did not evaluate duration of swab and number of swab twists performed. Participants were not asked if they had a swab performed on themselves, which may have improved their knowledge of accurate technique. Although an angle of 70 degrees was chosen to reflect clinical practice, alteration of head position in clinical settings may allow improved access to the nasopharynx. Only technique in nasopharyngeal swab was assessed but testing of specimens from multiple sites may improve overall sensitivity.20

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.10.19.20213140 on medRxiv