Throat, Nasal and Wound Swab Collections

Safety, Patient Identification, and Transport Fundamentals

Specimen collection begins with patient safety and verification. A phlebotomist must verify the patient's identity using at least two unique identifiers before collecting any swab specimen. Prior to beginning, the phlebotomist must explain the collection procedure to the patient. Proper hand hygiene must be performed before putting on gloves and immediately after glove removal. Standard precautions and transmission-based precautions dictate personal protective equipment: wear gloves and any additional mask, eye protection, face shield, or gown required by the collection procedure and the patient's precautions. A face shield does not replace a mask or respirator. When caring for patients with specific precautions, follow required transmission-based precautions: use a fit-tested N95 or higher-level respirator for airborne precautions and a medical mask for droplet precautions, with eye protection as indicated.

Accurate labeling protects patient safety and specimen integrity. Label each swab container immediately after collection, in the patient's presence and before leaving the collection area. Swab containers must be labeled with at least two patient identifiers, the collection date and time, the anatomical source, and collector identification as required by facility policy. Current or recent antimicrobial therapy must be recorded on the requisition if known and required by laboratory protocol, and any missing required information must be reported to the nurse or supervisor. A phlebotomist must never submit an unlabeled, mislabeled, dried-out, or expired-tube swab as an acceptable specimen; notify the nurse or supervisor and follow laboratory policy for rejection and recollection.

Transport systems ensure that pathogens remain viable for testing. Swab transport media maintain the viability of microorganisms without permitting excessive overgrowth before laboratory processing. Stuart and Amies media are commonly used transport systems for bacterial culture preservation. When using these systems, crush a transport device's ampule only if its manufacturer's instructions require activation, then secure the swab in the medium as directed. Viral transport media contain buffered salt solutions with proteins and antibiotics to preserve viruses and inhibit bacterial overgrowth. Transport bacterial culture swabs promptly within the time limits specified by the laboratory and transport device, with delivery within two hours being preferable when feasible. Maintain bacterial swabs at the temperature specified by the laboratory and transport device; many routine bacterial swabs can be kept at room temperature during prompt transport. If transport is delayed, store viral swabs at the temperature specified by the test and transport medium, as many specimens in viral transport medium require refrigeration at 2 to 8 °C.

The phlebotomist operates within a defined scope of practice. The phlebotomist must never diagnose conditions, prescribe treatments, or interpret swab culture results for the patient. In addition, any patient refusal, severe discomfort, or specimen collection complication must be documented and reported promptly to the nurse or supervisor.