Assessing the Impact of a Training Initiative for Nasopharyngeal and Oropharyngeal Swabbing for COVID‐19 Testing

Abstract

Objective The accuracy and reliability of COVID-19 testing are critical to limit transmission. After observing variability in testing techniques, we otolaryngologists at a tertiary medical center initiated and evaluated the impact of nasopharyngeal and oropharyngeal swabbing training, including video instruction, to standardize sampling techniques and ensure high-quality specimens. Methods Participants in the training were employees (N = 40). Training consisted of an instructional video on how to perform nasopharyngeal and oropharyngeal swabs and a live demonstration. Participants completed pre- and posttraining surveys assessing their knowledge and confidence in performing nasopharyngeal and oropharyngeal swabs. They then performed swabbing on partners, which was graded per a standardized checklist. Results Mean scores for knowledge-based questions and confidence in swabbing were significantly higher after the training session (both P < .001). All participants scored ≥6 of 8 on the posttraining checklist. Ninety-five percent rated the video as very or extremely useful. Discussion Specialized instruction for nasopharyngeal swabbing improved participants’ knowledge—specifically, the appropriate head position and minimum swab time in nasopharynx—and their confidence. After the training, their swabbing execution scores were high. Implications for Practice Video-assisted hands-on instruction for nasopharyngeal swab sampling can be used to standardize teaching. When prompt and accurate testing is paramount, this instruction can optimize procedural technique and should be used early and often. In addition, there may be a professional responsibility of otolaryngologists to participate in such initiatives.

Valid and Reliable Assessment of Upper Respiratory Tract Specimen Collection Skills during the COVID-19 Pandemic

“…However, COVID-testing is a relatively simple procedure requiring limited and relatively elementary knowledge and skills, which may indicate a short learning curve that combined with the standardized simulated model may have resulted in some level of ceiling effects. The good effect of a short simulation-based URTS training is also comparable to other studies with similar findings [21,22]. This indicates that URTS is a well-defined procedure where non-healthcare educated workers can perform URT samples comparably to experts if they receive focused and standardized training [23].…”

Role of the otolaryngologist in nasopharyngeal swab training: A case report and review of the literature

“…There have been a number of instructional videos for this purpose [ 30 , [35] , [36] , [37] , [38] ]. Simulation programs involving nasopharyngeal swabs have reported a 45–51% increase in levels of self-perceived competence in ability to perform and a 77.5% correct first-attempt swab [ 13 , 15 ].…”

“…However, as more HCWs from a diverse background are recruited to perform nasopharyngeal swabs, the appropriateness of doing so without adequate training has been called into question [ [12] , [13] , [14] , [15] ]. Although for the vast majority of cases, the swab is a safe and effective tool to combat the pandemic, HCWs should be aware of the shortcomings of this test.…”

Discrepancy of SARS-CoV-2 PCR results due to the sample collection sites and possible improper sampling

“…And more, the results of whole-genome sequencing were identical between the nasopharyngeal swab samples obtained at the previous hospital and our hospital. The well-known reasons for false-negative PCR results are inadequate sampling timing, sampling techniques, storage, transportation, processing of specimens, and technical problems related to the PCR [ 4 , 5 ]. We confirmed that the results of PCR tests varied depending on the type of samples among nasopharynx wiping, suctioned sputum, and tongue wiping samples even obtained on the same day.…”

“…Therefore, although infrequent, false-negative results can lead to misdiagnosis of COVID-19. Inadequate sampling is a well-known reason for false-negative PCR results [ 4 , 5 ]. The duration of SARS-CoV-2 infectivity remains unclear, and it is crucial for understanding transmission dynamics and implementing effective infection control mechanisms.…”