Obtaining a Nasal Swab

Skill 18-1

Obtaining a Nasal Swab

A nasal swab provides a sample of cells from the nostril that can be cultured, which can aid in the detection of viruses and bacteria that cause respiratory infections, such as influenza, COVID-19, and respiratory syncytial virus (RSV) (MedlinePlus, 2021a). A nasal swab can be part of the screening process to detect infection with drug-resistant microorganisms, such as methicillin-resistant Staphylococcus aureus (MRSA) (MedlinePlus, 2021a), and coronavirus testing (CDC, 2019c).

Delegation Considerations

Obtaining a nasal swab is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, this procedure may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Nasal swab
Sterile water (optional)
Nonsterile gloves
Goggles and face mask, or face shield
Additional PPE, as indicated
Biohazard bag
Appropriate label for specimen, based on facility policy and procedure

Assessment

Assess the patient's understanding of the collection procedure, the reason for testing, and their ability to engage in care. Inspect the patient's nares and for the presence of nasal symptoms, such as discharge, erythema, or congestion. Assess for conditions that would contraindicate obtaining a nasal swab, such as injury to the nares or nose, and surgery of the nose.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Infection risk
Acute pain
Knowledge deficiency

Outcome Identification and Planning

The expected outcomes to achieve are that an uncontaminated specimen is obtained without injury to the patient and sent to the laboratory promptly. Additional outcomes that may be appropriate include that the patient verbalizes an understanding of the rationale for and the steps of the procedure.

Implementation

Action	Rationale
1. Verify the prescribed intervention for a nasal swab in the patient's health record. Gather equipment. Check the expiration date on the swab package.	Verifying the prescribed intervention is crucial for ensuring that the proper procedure is administered to the right patient. Assembling equipment provides for an organized approach to the task. The swab package is sterile and should not be used past the expiration date.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the transmission of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
4. Explain the procedure to the patient. Discuss with the patient the need for a nasal swab. Explain to the patient the process by which the specimen will be collected.	Discussion and explanation help to allay some of the patient's anxiety and prepare the patient for what to expect.
5. Check the specimen label with the patient identification bracelet. The label should include the patient's name and identification number, the time the specimen was collected, the route of collection, identification of the person obtaining the sample, and any other information required by facility policy.	Confirmation of patient identification information ensures the specimen is labeled correctly for the right patient.
6. Assemble equipment on the overbed table or other surface within reach.	Arranging items nearby is convenient, saves time, and avoids unnecessary stretching and twisting of muscles on the part of the nurse.
7. Close the curtains around the bed or close the door to the room, if possible.	Closing the door or curtain provides for patient privacy.
8. Put on goggles, a face mask or face shield, and nonsterile gloves.	Goggles, a face mask or face shield, and gloves protect the nurse from exposure to blood or body fluids and prevent the transmission of microorganisms. Irritation to the nose during collection with the nasal swab may cause the patient to sneeze or cough.
9. Place the bed at an appropriate and comfortable working height (VHACEOSH, 2016). Ask the patient to tip their head back slightly. Assist, as necessary.	Having the bed at the proper height prevents back and muscle strain. Tilting the head allows optimal access to the nares, which is where the swab will be inserted.
10. Peel open the swab kit packaging to expose the swab and collection tube. Remove the white plug from the collection tube and discard. Remove the swab from the packaging by grasping the exposed end. Take care not to contaminate the swab by touching it to any other surface. Moisten with sterile water, depending on facility policy.	The swab must remain sterile to ensure the specimen is not contaminated. Moistening the end of the swab minimizes discomfort to the patient.
11. Insert the swab 1.5 cm into one naris (Figure 1) and rotate it against the anterior nasal mucosa at least four times for a total of 15 seconds (CDC, 2019; MedlinePlus, 2021a).	Contact with the mucosa is necessary to obtain potential pathogens.
12. Remove the swab and repeat in the second naris, using the same swab.	Repeating in the second naris ensures accurate specimen.
13. Insert the swab fully into the collection tube, taking care not to touch any other surface. The handle end of the swab should fit snugly into the collection tube, and the end of the swab should be in the culture medium at the distal end of the collection tube. Lightly squeeze the bottom of the collection tube as necessary, depending on the type of tube in use in the facility, to break the seal on the culture medium.	The swab must remain uncontaminated to ensure accurate results. Full insertion of the swab ensures it will remain in the collection tube. Placement of the swab end in culture medium and releasing the liquid transport medium are necessary to ensure accurate specimen processing.
14. Dispose of used equipment per facility policy. Remove gloves. Perform hand hygiene.	Proper disposal of equipment reduces the transmission of microorganisms. Removing gloves properly reduces the risk for infection transmission and contamination of other items. Hand hygiene reduces the transmission of microorganisms.
15. Place a label on the collection tube per facility policy. Place the container in a plastic, sealable biohazard bag.	This ensures the specimen is labeled correctly for the right patient and ensures proper processing of the specimen. Packaging the specimen in a biohazard bag prevents the person transporting the container from coming in contact with the specimen.
16. Remove the face shield and other PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene reduces the transmission of microorganisms.
17. Transport specimen to the laboratory immediately. If immediate transport is not possible, check with laboratory personnel or the policy manual to see whether refrigeration is contraindicated.	Timely transport ensures accurate results.

Evaluation

The expected outcomes have been met when an uncontaminated specimen has been obtained without injury to the patient and sent to the laboratory promptly, and the patient has verbalized an understanding of the rationale for and the steps of the procedure.

Documentation

Guidelines

Record the time the specimen was collected and sent to the laboratory. Document any pertinent assessments of the patient's nares and the presence of nasal symptoms, such as discharge, erythema, or congestion.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Swab touches surface other than inner aspect of nares on entry or exit: Discard the swab, obtain a new culture swab, and recollect the specimen.

Special Considerations

If the patient has injury to the nares or nose or has had nose surgery, the nurse should contact the health care team to discuss collection of the specimen. These conditions may prohibit collection.

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Skill 18-1