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
   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. 3.Show
   Remove swab from outer packaging.
   To ensure collection of specimen material. E
2. 4.Show
   Ask patient to tilt head backwards.
   To optimize visualization of the area to be swabbed (Gould and Brooker [75], E).
3. 5.Show
   Moisten swab with sterile saline.
   To prevent discomfort to the patient as the nasal mucosa is normally dry and organisms will adhere more easily to a moist swab. E
4. 6.Show
   Insert swab inside the anterior nares with the tip directed upwards and gently rotate (Action figure 13.23).
   To ensure that an adequate specimen from the correct site is obtained and to avoid damage to the epithelium, which is delicate (Gould and Brooker [75], E).
5. 7.Show
   Repeat the procedure with the same swab in the other nostril.
   To optimize organism collection. E

Post‐procedure

1. 8.Show
   Remove cap from plastic transport tube.
   To avoid contamination of the swab. E
2. 9.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. 10.Show
   Provide the patient with a tissue if required.
   For patient comfort (Higgins [84], E).
4. 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).
5. 12.Show
   Label swab immediately
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
6. 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).
7. 14.Show
   If sample taken for screening: state clearly on the microbiology request form, for example for MRSA screening.
   To ensure only these organisms are being analysed, so the result will only indicate their presence or absence, and sensitivities (Weston [255], E).
8. 15.Show
   Arrange prompt delivery to the microbiology laboratory.
   To achieve optimal conditions for analysis (PHE [186], C).
9. 16.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).