A GUIDE TO COLLECT AND HANDLE CLINICAL SPECIMENS FOR SARS-CoV-2

We are well aware of the current situation of a pandemic due to SARS-CoV-2. According to the latest research, a delta variant (previously known as the Indian variant) is discovered and can cause another wave in India. To tackle this, everyone is advised to follow all the SOPs and get vaccinated as soon as possible. 

This blog will provide the proper guidelines for collecting and handling specimens for the SARS-CoV-2 virus. 

SAFETY DURING COLLECTION AND HANDLING:

The primary concern for healthcare providers during collection and handling should be safety. When healthcare providers collect specimens while standing under 6 feet of the patient (who is suspected for covid-19), proper infection control should be maintained, and PPE (personal protective equipment) should be mandatory. PPE kit must include a high-level respirator or N95, a gown, gloves, and eye goggles. 

If a healthcare provider is handling specimens but is not involved in the collection process or not standing under 6 feet of the patient, he must follow standard SOPs and wear a face mask at all times while in the facility. 

COLLECTION OF RESPIRATORY SPECIMENS:

If a decision to test someone is made, the respiratory specimen should be collected in no time. For respiratory specimen collection, the condition of symptoms should not be a concern. 

For any disease diagnosis, the collection of the specimen is the most crucial step. If a specimen is not collected correctly, it may lead to inconclusive results. In this section, a proper guideline will be explained to collect specimen efficiently. 

We can use two options for specimen collection, upper respiratory tract and lower respiratory tract. For initial testing, the upper respiratory tract is a better option. In this option, sterile swabs (Nasopharyngeal swabs or oropharyngeal swabs) should be used.  In a study for self-collected swab test with upper tract method (1), Nasopharyngeal swab showed the efficiency up to 94%. The test was conducted on 240 adults. 

In some instances (patients with invasive mechanical ventilation), lower respiratory tract specimens can be used for collection. 

• UPPER RESPIRATORY TRACT:

In the upper respiratory, one is recommended to use only a synthetic fibre swab with a thin plastic shaft (it must be designed for nasopharyngeal mucosa). Use of calcium alginate swab is not recommended. Due to some substances, these swabs may inactivate viruses. If a healthcare provider collects both NP and OP specimens, they should merge them in a tube for efficiency. 

• LOWER RESPIRATORY TRACT:

Sputum (Trained healthcare professional as a guide in this collection):

If a patient has developed a cough, sputum can be used to test the availability of SARS-CoV-2. The trained healthcare professional should educate and teach the patient about the difference between secretions (spit) and sputum (deep cough). Ask the patient to rinse the mouth and then develop sputum and spit it into sterile. 

LUNG BIOPSY, PLEURAL FLUID, TRACHEAL ASPIRATE, BRONCHOALVEOLAR (Performed by a physician):

Collect specimen into a sterile or sterile dry container. The collection of specimens (not sputum) from the lower respiratory method is limited to patients’ increased technical skills.

HANDLING BULK – PACKAGING OF STERILE SWAB FOR SPECIMEN COLLECTION:

There are two ways to pack sterile swabs for the upper respiratory tract. 

1. Bulk package.
2. Individually wrapped. 

The bulk package can be used if the individually wrapped collection is not available. Keep one thing in mind, protecting bulk packages and prevent for contamination is not easy. Hence, extra care is required. 

1. If using the bulk package, divide individual swabs from containers to individual disposable bags.  Perform this before you wear the PPE kit. 
2. If individual packaging is not possible:

1. Use new gloves to handle a single swab from the container. 
2. Make sure all the used swabs are kept out of the container. 

1. If a patient self-collects specimen (under supervision):

1. Wear protective gloves to provide swabs to the patient. 
2. Once swabbed, the patient can place the swab in a sterile transport device, seal, or transport media. 
3. If assistance is required, use transport media to help the patient. 

STORING RESPIRATORY SPECIMENS:

Do not store specimens for more than 72 hours. Storage temperature should not exceed 8C, and it should not be less than 2C. If, in any case, the test gets delayed (more than 72 hours), store the specimen at -70C or below. 

CONCLUSION:

Sars-Cov-2 has stopped the world’s economic wheel. The virus has the potential to harm millions. To fight this unseen enemy, we must follow strict SOPs. Especially those healthcare providers who work near covid-19 patients must follow strict standards of procedures.  

Bibliography

1. “Self-Collected Upper Respiratory Tract Swabs for Covid-19 test”: A feasible way to increase overall testing rate and conserve resources in South Africa. Adeniji, Adeloye A. s.l. : African Journal of Primary Health Care & Family Medicine, 2020.