COVID-19 Testing: Sample Collection and Submission

Purpose:

Explain how to safely collect a COVID-19 nasopharyngeal sample and prepare the sample for pick-up.

Regulation:

Policy:

Account Information

When submitting the order by phone for pick up you will need to provide the account number for the branch.  It's important to confirm the address with them as well:

Process:

Competency

1. Print
   1. Competency checklist for each clinician based on the competency that will be demonstrated (nasopharyngeal/oropharyngeal)
      1. Nasopharyngeal sample competency checklist.docx
      2. Oropharyngeal sample competency checklist.docx
   2. Sample collection guide based on the type of sample the clinician is being competency tested on (nasopharyngeal/oropharyngeal).
      1. COVID-19 Nasopharyngeal Sample Collection Guide.pdf
      2. COVID-19 Oropharyngeal Sample Collection Guide.pdf
         1. Clinician will review the sample collection guide prior to demonstrating the process of obtaining a sample.
2. Watch a video demonstration on the proper way to provide a nasopharyngeal swab test.

Competency Demonstration

1. Return demonstration may be done on a mannequin or live person.  Live person is preferable
   1. Offer to 4-5 employees to be swab tested by our clinicians being competency tested
      1. Get a physician order.  The lab requires it.
         1. If unable to get a physicians order from the employees physician, seek one from the medical director
      2. Get a signed consent from the employee to provide the swab test.  Consent for COVID-19 test
      3. Get the employees health insurance information.  We will bill for the swab test.
      4. There will be no cost to the employee
         1. The cost for the testing will be covered for employees that are exposed or potentially exposed by a Recover Health client or Recover Health employee.
            1. The cost for testing will not be covered if the employee was exposed or potentially exposed from persons outside of Recover Health "client to employee" or "employee to employee."
         2. The employees health insurance will be billed.  If there is out of pocket expense such as not covered or a co payment, the bill can be given to the Recover Health office to pay or reimburse the employee.
2. The clinician may watch the demonstration via video or other experience people such as an RN, LPN, Medical assistant etc...
   1. Only an RN, which could be the Clinical Manager or another RN, will deem an employee competent in this skill

Testing provided

1. Symptomatic
   1. If an employee or client are symptomatic with COVID-19 symptoms, testing will be provided.
      1. Get a physicians order to provide the test.
2. Asymptomatic
   1. If an employee was exposed to a  COVID-19 positive or a physician suspected COVID-19 client or other employee, we will test the "asymptomatic" employee after 3rd date of exposure.
      1. Example:    Employee learns their client tested positive for COVID-19 on 6/2/2020.   Employee first became exposed to this COVID -19 client on 6/3/2020.  On 6/5/2020 employee continues to not exhibit any symptoms and it's been 2 days since the exposure.  On 6/6/2020 employee continues to not exhibit any symptoms and it's been 3 days since the first exposure.  Since it has been 3 days or greater since exposure, the employee will be tested.
      2. Example:    Employee learns on 6/8/2020 their client tested positive for COVID -19 on 6/2/2020.  The employee has been working with this client 2xw and worked on 6/4/2020 with this client.  Since the employee was first exposed on 6/4/2020 and the employee is learning about it on 6/8/202, it has been 3 days or greater since the first exposure date.  The employee can be tested today.

Gather Supplies

1. PPE:  Depending on the client situation or local infection control guidelines, an N95 mask, eye protection and gown may be necessary.
   1. Symptomatic & Asymptomatic employee and/or client 
      1. For providers collecting specimens or within 6 feet of patients suspected to be infected with SARS-CoV-2, maintain proper infection control and use recommended personal protective equipment (PPE), which includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown, when collecting specimens.
      2. Collecting and Handling Specimens Safely   https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
2. Swab kit
   1. Contains one swab and a vial with solution
      1. Check the expiration date of both the swab and the vial
3. Divided, zip lock bag

Collect the Sample

1. Based on the competency demonstration, sample collection guide and video, collect the sample
2. Place the sample in the vial, breaking the swab at the perforated area
3. Place cap on the vial

After collection of sample

1. After collection of the specimen, enter the specimen information into the Quanum system using the COVID-19 Testing: Ordering Test Through Quanum process.
   1. Once completed in Quanum, print the test requisition form to be placed with the specimen.    
   2. Call Quanum for a pick up once the swab test has been completed.  866-MYQUEST (1-866-697-8378).
      1. A QUEST lab may not be local to the office, but QUEST has courier services local to each branch.
         1. Depending on location of the branch, each branch will have a different pick up time.  Due to the timing of pick up for each location, courier services may not be available for the day the swab was taken.  In this event, the courier service will come the next day.
         2. If weekend services are needed, some labs are open on Saturdays but never on Sundays.  When you call for a pick up on the weekend, the lab will inform you if courier services are available or not.  If not, the pick up can be scheduled for the following Monday.
            1. Swab specimens are stable for up to 5 days at room temperature.
2. Open the zip lock bag provided by QUEST Diagnositics
   1. Inside, the bag is divided into two compartments.
   2. One specimen bag per patient per temperature requirement.
3. Place the specimen container (vial) in the front pouch.
   1. The front pouch is the printed side.
4. Place the test requisition in the rear pouch (unprinted side) with barcode visible in the bottom corner of the bag.
5. Press zip-lock firmly across entire length of zip.
   1. DO NOT staple
6. Place the swab in the designated provided lock box in area where the courier service can pick up the sample.
   1. Swabs samples are stable for up to 5 days at room temperature.
7. Indicate the transport temperature by checking one of the boxes on the bag (Room Temperature/Refrigerate/Frozen)
8. Once the specimen and requisition are in the bag, you can either schedule a pickup through Quanum or you can call 866-MYQUEST (1-866-697-8378).  
   1. You will need to provide your account number if you call.