Lower respiratory specimens

Screw cap plastic container (sterile)

Upper respiratory specimens

NP/OP swab sumbitted in Viral Transport Media (M4 or M5)

• The CDC recommends the collection of specimens from lower respiratory tract and upper respiratory tract. 
• At a minimum, MDH recommends the collection of at least one respiratory specimen (upper or lower).

Lower respiratory specimen are collected in a sterile container
Sputum
Brocheoalveolar lavage
Bronchial wash
Tracheal aspirate
Pleural fluid

NP/OP swab collection

NP/OP specimens need to be combined, placing both swabs in the same VTM vial.

• Use only synthetic fiber swabs with plastic shafts.
• Do not use calcium alginate swabs or wooden shafted swabs.

Nasopharyngeal (NP) swab collection:

1. Tip the patient’s head back.
2. Gently insert the NP swab into the nostril parallel to the palate (not upwards) until resistance is encountered or the distance is equivalent to that from the ear to the nostril of the patient, indicating contact with the nasopharynx.   
   1. If any resistance is met in the passageways, do not force the swab; back off and try reinserting it at a different angle, closer to the floor of the nasal canal, or try the other nostril.
3. Gently rub and roll the swab for 10-15 seconds while the swab is in contact with the nasopharyngeal wall.
4. The CDC recommends leaving the swab in place for several seconds to absorb secretions.
5. Slowly remove the swab and place in the transport medium.
6. Break the swab shaft so that it fits into the medium container and recap tightly.
7. Label the specimen appropriately. Document the source “NP” on the label.

New England Journal of Medicine video on NP swab collection: Nasopharyngeal Swab Collection Video

Upper respiratory specimens

• Nasopharyngeal swab and oralpharyngeal swab (NP/OP swab)
• Instructions for collecting NP/OP swab: 
  • Use only synthetic fiber swabs with plastic shafts. 
  • Do not use calcium alginate swabs or swabs with wooden shafts.
  • Place swab into a sterile tube containing 2-3ml of viral transport media.
  • NP/OP specimens need to be combined, placing both swabs in the same vial.

Lower respiratory specimen:

Sterile container

Upper respiratory swab

NP/OP swab sumbitted in Viral Transport Media (M4 or M5)

MDH Infectious Disease Laboratory submission form

Refrigerated (preferred) - 72 hours

Frozen - 2 months

Calcium alginate or wooden shafted swabs

Polymerase Chain Reaction (PCR)

Information For Health Professionals on Middle East Respiratory Syndrome Coronavirus (MERS-CoV)