Variability in instructions for performance of nasopharyngeal swabs across Canada in the era of COVID-19 – what type of swab is actually being performed?

Table 1 Comparison of provincial and territorial health authority guidelines to the combined CDC, PAHO, and NEJM guidelines

	Combined CDC and NEJM Guideline for Collection of Nasopharyngeal Specimen
	Clear Nasal Passages	Head Placement	Angle of Swab Insertion	Depth of Swab Insertion	Swab Rotation	Swab Left in Place	Swab Removal	Swab Handling
Alberta [21]	✓	✓	✓		✓			✓
British Columbia [22]	✓	✓	✓		✓	✓		✓
Manitoba [23]	✓	✓	✓		✓	✓		✓
New Brunswick [19]	✓	✓	✓	✓	✓	✓		✓
Newfoundland and Labrador [24]	✓	✓	✓	✓	✓	✓		✓
Northwest Territories [21]	✓	✓	✓		✓			✓
Nova Scotia [25]	✓	✓	✓	✓	✓	✓		✓
Nunavut [26]	✓	✓	✓		✓			✓
Ontario [27]		✓	✓		✓	✓	✓	✓
Prince Edward Island [28]	✓	✓	✓		✓	✓		✓
Quebec [29]					✓			✓
Saskatchewan [30]		✓	✓		✓	✓		✓
Yukon Territory [31]	✓		✓	✓	✓			✓

Clear nasal passages – patient is instructed to blow their nose or the provider clears excess mucous prior to the swab; Head placement – tilted slightly back (i.e. at 70°); Angle of swab insertion – Parallel to palate along nasal floor; Depth of swab insertion – equal to at least approximately two-thirds the distance between the patient’s nose and ear; Swab rotation – the swab should be rotated several times at correct depth; Swab left in place – swab should be left at the nasopharynx for several seconds to absorb secretions; Swab removal – swab should be rotated while it is slowly removed; Specimen handling - tip of swab is to be placed into sterile viral transport media tube and the applicator stick is snapped or cut off

ISSN: 1916-0216