FDA: Clinicians need to provide patients with instructions for personal collection of COVID-19 nasal samples

On October 7, FDA advised health care personnel, including pharmacists and pharmacy technicians, to provide patients with clear instructions on collecting their own nasal swab samples for on-site COVID-19 testing.

In addition to verbal instruction, FDA said health care personnel should provide visual step-by-step instructions to patients as well. FDA included examples of each:

  • Written instructions are available from CDC or Audere's HealthPulse communication.
  • Video or animated instruction is also available from Audere’s HealthPulse communication. (Audere, a Washington State nonprofit, has granted a general right of reference to any organization who wishes to access and use these instructions for lower nasal swabs administered at a testing site.)

The instructions provided to patients should incorporate the following information, said FDA:

  • The entire tip of the swab (usually 1/2 to 3/4 of an inch) should be placed inside the nose, and the side of the swab tip should be rubbed with moderate pressure against as much of the wall of the anterior nares region as possible, moving the tip through a large circular path inside the nose.
  • At least four of these sweeping circles should be performed in each nostril using the same swab. This should take approximately 10 to 15 seconds per nostril.
  • Simply twirling the swab against one part of the inside of the nose or leaving the swab in the nose for 10 to 15 seconds is not proper technique and may result in an insufficient sample.

Nasal swab samples have their benefits—including feeling more comfortable for patients than other upper respiratory specimen collection—but only if they are done correctly.

Without clear instruction, FDA said “patients who, in a health care setting, are self-collecting anterior nares (nasal) samples may not collect an adequate sample for testing, which may decrease the sensitivity of the test. Health care providers have a critical role in helping patients perform self-collection accurately.”