Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [165], C).
2. 2.Show
   Seek advice from the microbiology laboratory as to the correct culture medium and swab required.
   Different culture media and swabs are required for bacteria, viruses and chlamydia (Shaw et al. [226], E).
3. 3.Show
   Wash hands with bactericidal soap and water, or decontaminate physically clean hands with an alcohol‐based handrub. Put on apron and gloves.
   To reduce the risk of cross‐infection and specimen contamination (NHS England and NHSI [155], C).

Procedure

1. 4.Show
   Remove swab from outer packaging.
   To ensure collection of specimen material. E
2. 5.Show
   Ask patient to look upwards.
   To prevent corneal damage (Shaw et al. [226], E).
3. 6.Show
   Hold the swab parallel to the cornea and gently rub the conjunctiva in the lower eyelids from nasal side outwards.
   To ensure that a swab of the correct site is taken and to avoid contamination by touching the eyelid (Shaw et al. [226], E).
4. 7.Show
   If for chlamydia specimen: apply slightly more pressure when swabbing.
   To obtain as many organisms as possible from the follicles and to sweep organisms away from the lower punctum (Shaw et al. [226], E).
5. 8.Show
   If both eyes are to be swabbed, label swabs ‘right’ and ‘left’ accordingly.
   To prevent the wrong swab being placed in the wrong culture medium (Shaw et al. [226], E).

Post‐procedure

1. 9.Show
   Remove cap from plastic transport tube.
   To avoid contamination of the swab. E
2. 10.Show
   Carefully place swab into plastic transport tube, ensuring it is fully immersed in the transport medium. Ensure cap is firmly secured.
   To avoid contamination of the swab and to maintain the viability of the sampled material during transportation. See manufacturer's guidance. E
3. 11.Show
   Remove gloves and apron, and wash and/or decontaminate hands.
   To reduce the risk of cross‐infection (NHS England and NHSI [155], C).
4. 12.Show
   Label swab immediately.
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
5. 13.Show
   Complete microbiology request form (including relevant information such as exact site, nature of specimen and investigation required).
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
6. 14.Show
   Arrange prompt delivery to the microbiology laboratory.
   To achieve optimal conditions for analysis (PHE [189], C).
7. 15.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).