Pandemic Influenza Plan - Questar III

Section 2: Surveillance and Laboratory Testing
• Nasopharyngeal wash: Use rubber bulb (1-2oz for infants) or syringe to
instill 3-5 ml of non-bacteriostatic saline into one nostril while occluding the
other. If patient is able to cooperate, instruct them to close glottis by making
a humming sound with mouth open. If a rubber bulb is used, release pressure
on bulb to allow saline and mucus to enter bulb. Remove from nose and
squeeze into vial of transport media. If syringe is used, apply suction to
syringe to recover saline and nasal secretions. Alternately, hold sterile
container, such as a urine cup, under patient’s nose and ask patient to expel
material into it. In either case, add recovered saline-nasal secretions to a vial
of viral transport media.
• Nasopharyngeal swab: Use a swab with a fine, flexible metal shaft and
Dacron or rayon tip. Insert swab into posterior nasopharynx. Rub swab
against mucosal surface and leave in place for 5 seconds to absorb secretions.
Collection of specimens from both nostrils increases amount of material
available for analysis. Place both swabs in a vial of viral transport medium.
Use scissors to cut the shaft so top of vial can be screwed on tightly.
• Oropharyngeal swab: Use only sterile Dacron or rayon swabs with plastic
shafts, swab both posterior and tonsillar areas, avoiding the tongue. Place
swab in a vial of viral transport medium and break shaft.
o Acceptable specimens for patients who have a history of travel to an area
where the avian influenza virus is endemic or are suspected to be infected
with a novel influenza virus:
• While it appears that lower respiratory tract secretions may have a higher
viral load than upper respiratory secretions in patients infected with these
strains of avian influenza virus (e.g., H5N1) or other novel viruses, collecting
these samples may present a risk to health care providers. If appropriate
personal protective equipment is not available, lower respiratory tract
secretions should NOT be collected and sample collection should be
restricted to nasopharyngeal and oropharyngeal swabs collected as
above. Each sample should consist of one nasopharyngeal and one
oropharyngeal swab contained in one sterile vial of at least 2ml of viral
transport medium.
The hospital laboratory may perform a rapid influenza antigen detection assay
using standard BSL-2 work practices in a Class II biological safety cabinet.
Regardless of the result, the specimens should still be referred to the
Wadsworth Center for testing.
• Obtain a blood specimen (not anti-coagulated) from the suspect case and
submit the serum, not the blood sample, along with the respiratory samples.
In addition to the patient identifier, label the serum with the date and time of
February 7, 2006 2-16