Collection of Diagnostic Respiratory Specimens - HAN
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Overview
Considerations for Collection of Diagnostic Respiratory Specimens
Some specimen collection guidance has changed since July 8, 2020. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). When collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) from a patient with possible COVID-19, the following should occur:
- Specimen collection should be performed in a normal examination room with the door closed.
- HCP in the room may wear a facemask, eye protection, gloves, and a gown.
- N95 respirators should be prioritized for other procedures at higher risk for producing infectious aerosols (e.g., intubation), instead of for collecting nasopharyngeal swabs.
- The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.
Outpatient Environmental Infection Control Tips
- Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings.
- Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
- Clean and disinfect procedure room surfaces promptly after diagnostic respiratory specimens obtained. In general, only essential personnel should enter the room of patients with suspected or confirmed COVID-19.
- Although spread of SARS-CoV-2 is believed to be primarily via respiratory droplets, the contribution of small respirable particles to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely.
- The amount of time that the air inside an examination room remains potentially infectious is not known and may depend on a number of factors including the size of the room, the number of air changes per hour, how long the patient was in the room, if the patient was coughing or sneezing, and if an aerosol-generating procedure was performed. Facilities will need to consider these factors when deciding when the vacated room can be entered by someone who is not wearing PPE.
- For a patient who was not coughing or sneezing, did not undergo an aerosol-generating procedure, and occupied the room for a short period of time (e.g., a few minutes), any risk to HCP and subsequent patients likely dissipates over a matter of minutes. However, for a patient who was coughing and remained in the room for a longer period of time or underwent an aerosol-generating procedure, the risk period is likely longer.
- For these higher risk scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the airborne route (e.g., measles, tuberculosis) and to restrict HCP and patients without PPE from entering the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.
- HCP already in PPE or Environmental Services (EVS) personnel may enter the room after sufficient time has elapsed, depending on the use of the room as above, and should wear a gown and gloves when performing terminal cleaning. HCP/EVS personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient.
- A facemask (if not already wearing for source control) and eye protection should be added if splashes or sprays during cleaning and disinfection activities are anticipated or otherwise required based on the selected cleaning products. Shoe covers are not recommended at this time for personnel caring for patients with COVID-19.
COVID-19 Reporting
For Clinical Questions Or To Report Suspect Cases, Contact:
The CDPH Disease Reporting Hotline at 312-743-9000