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 sit upright facing a strong light, tilt head backwards, open mouth and stick out tongue.
   To ensure maximum visibility of the area to be swabbed and avoid contact with the oral mucosa (Gould and Brooker [75], E).
3. 5.Show
   Depress tongue with a spatula.
   The procedure may cause the patient to gag. The spatula prevents the tongue moving to the roof of the mouth, which would contaminate the specimen. E
4. 6.Show
   Ask patient to say ‘Ah’.
   Assists with depression of the tongue and prevents the patient from feeling the gag reflex. E
5. 7.Show
   Quickly but gently roll the swab over any area of exudate or inflammation or over the tonsils and the posterior pharynx (Action figure 13.24).
   To obtain the required sample (Weston [255], E).
6. 8.Show
   Carefully withdraw the swab, avoiding touching any other area of the mouth or tongue.
   To prevent contamination of the specimen with the resident flora of the oropharynx (Weston [255], 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 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).