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Introduction ⬇

The coronavirus disease 2019, known as COVID-19, is a coronavirus infection caused by SARS-CoV-2. COVID-19 was first recognized in December 2019 in Wuhan, China, and resulted in a global pandemic. The most common routes of transmission are coughing, sneezing, and talking, which spread small droplets into the air that may be inhaled or land onto surfaces, which can cause transmission by touch. Molecular testing, which uses PCR technique, tests for current infection using a nasopharyngeal or oropharyngeal swab specimen or saliva specimen. Recent or prior infection can be detected via an antigen blood test that identifies IgG antibodies to SARS-CoV-2. Antibody testing is recommended in people 10 days after symptoms or exposure to COVID-19.

Procedure ⬆ ⬇

  1. Collect a respiratory tract specimen or blood sample.

  2. Respiratory specimens may be collected by nasopharyngeal or oropharyngeal swabs, nasopharyngeal aspirate or washing BAL or sputum, or saliva.

    1. Nasopharyngeal or oropharyngeal specimens can be obtained by inserting a swab into the nostril or posterior pharynx, respectively. The swabs should then be placed into sterile vials containing 2 mL of viral media.

    2. Nasopharyngeal aspirates are collected by instilling 1–1.5 mL of nonbacteriostatic saline into one nostril and then subsequently aspirating, through a plastic catheter, into a sterile vial.

    3. Saliva specimen is collected by having the patient spit several times into a tube, then sealing the tube securely.

  3. For antigen testing: Obtain at least 2 mL serum.

  4. Label specimens with the patient’s name, date, and test(s) ordered and place specimens in a biohazard bag.

Clinical Implications ⬆ ⬇

  1. Positive results for antibody testing suggest recent or prior infection with SARS-CoV-2.

  2. Evidence of current infection requires quarantine and protective measures to prevent infecting caregivers or family members as well as reporting to the appropriate public health agency.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain necessity, purpose, and procedure of testing. Assess for and document signs and symptoms of infection (fever, cough, shortness of breath, muscular weakness). Ask the patient about travel (especially travel within the last 14 days to a COVID-19–affected area), living accommodations, and contact with suspected cases. Also, ascertain whether the individual is a healthcare worker who may have been in direct contact with patients.

  2. Close contact (e.g., living with or taking care of a person with COVID-19) or close conversation (lesser than 6 feet) may result in transmission of the infection.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Assess for and document any change in signs and symptoms.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. If you are caring for someone with COVID-19, you should protect yourself by wearing a mask, frequent handwashing, and practicing social distancing when possible.

  2. Clean all contaminated surfaces with household disinfectant.

Reference Values ⬆

Normal

Molecular testing: negative for COVID-19 at time of testing

Antigen testing: negative for SARS-CoV-2 antibody

Clinical Alert

Evidence of COVID-19 should be reported to local, state, and federal health departments.