Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers

Abstract

Objectives/Hypothesis Nasopharyngeal swabs currently remain the gold standard for COVID‐19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false‐negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D‐printed nasal swab simulator to expedite health care workers' skill acquisition. Study Design Prospective pre‐post interventional study. Methods A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID‐19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self‐evaluate procedure accuracy. A five‐point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. Results Sixty‐two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self‐assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety‐four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty‐one indicated that the simulator should be used at all COVID‐19 testing sites, with 77% stating province‐wide implementation was warranted. Conclusions The nasal swab task trainer is an effective educational tool that appears well‐suited for improved skill acquisition in COVID‐19 testing and may be useful for training other nasal swab applications. Level of Evidence 3 Laryngoscope , 2022

How deep do you go? Clinical prediction of nasopharyngeal depth based on facial measurements

“…Attempts to train healthcare workers on proper nasopharyngeal swab technique have improved procedural accuracy and self‐confidence using group training sessions and simulation (Instrum et al, 2022; Mark et al, 2020). Heterogeneous ND insertion among guidelines (Hiebert et al, 2021) for this procedure has implications extending beyond the test accuracy, and these measurements should help standardize what is regarded as a “nasopharyngeal swab.” However, since the performance of these swabs is based on tactile feedback along the patient's nasal cavity, estimating individualized ND seems necessary as a pretest method to predict the appropriate depth of swab insertion and appropriately label the performed swab (mid‐turbinate versus anterior nasal versus nasopharyngeal).…”

“…Attempts to train healthcare workers on proper nasopharyngeal swab technique have improved procedural accuracy and selfconfidence using group training sessions and simulation (Instrum et al, 2022;Mark et al, 2020). Heterogeneous ND insertion among guidelines (Hiebert et al, 2021) for this procedure has implications extending beyond the test accuracy, and these measurements should help standardize what is regarded as a "nasopharyngeal swab."…”

Nasopharyngeal Swabs in Pediatric Patients With Thrombocytopenia and Anticoagulant Use

“…1 Proper NP swab technique mitigates injury caused by the swabbing process. 3,4 Pediatricians and pediatric hematology/oncology (PHO) specialists must balance the benefit of NP testing with the risk of harm to their patients. PHO patients are frequently evaluated for febrile illness associated with central lines or neutropenia with viral respiratory tract symptoms, in which case NP testing may provide diagnostic value.…”

“…Predisposing conditions to NP swab sequelae include previous rhino surgery, anatomic abnormality, anticoagulation, and hematologic disorders 1 . Proper NP swab technique mitigates injury caused by the swabbing process 3,4 …”