Aseptic technique for NPA collection

Transcription

1 PTCOC Commissioned Training Infection Control for Physiotherapists (Workshop) Aseptic technique for NPA collection By Mr. Tony AU Physiotherapist, TKOH

2 Nasopharyngeal Aspirate (NPA) Useful for diagnosis of viral diseases such as Influenza Coronarvirus Parainfluenza virus Respiratory syncytical virus

3 PT Clinical Experience

4 PWH AED RN specifically trained in NPA Techniques (A K C Wai and et al 2007 ) TKOH RN & PT specifically trained in NPA Techniques Nasopharyngeal specimens are collected by referring clinician or by Patient Services Staff with current competency certificate ( St Vincent s s Pathology 2006 )

5 How to perform NPA in a safe manner Risk Assessment

6 Travel Occupation Contact Cluster

7 Risk ASSESSMENT Procedures with Aerosol generating potential or, Extensive dispersal of droplets or, Prolonged close contact of dependent patients

8 Recommended PPE N95 respirator Disposable gown Eye protection Latex gloves Cap WHO guideline 2005 Standard precautions and barrier protection

9 Preparation for NPA Specimen bottle (Mucus extractor) TM bottle (viral transport media) Suction catheter of appropriate size Wear PPE negative pressure room / aerosol removing device Explain procedure to patient & place a surgical mask over his/her mouth. WASH HANDS before and after procedure

10 How to perform NPA Connect mucus extractor to suction catheter and wall suction tubing Measure the distance, from the patient s nostril to nasopharynx (which is the distance from the base of nostril to the earlobe) Apply suction force with mmhg neonate: mmHg, children: mmHg

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12 Insert thro Nostril Patient sit with the neck slightly extended ( A K C Wai 2007 ) Neck extension is important as this allows pooling of the aspirate in the nasopharynx ( ) Instruct to hold the breath ( A K C Wai 2007 ) Pass the tube along the nose into the nasopharynx until posterior pharyngeal wall is reached. Apply suction force <10 seconds. Rotate the catheter for several times The aspirate sample is adequate if at least 1cc is collected ( ) Dip the catheter tip into transport media. Suck the whole transport media into the mucus extractor.

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14 Screw up the trapper tightly and send out with appropriate lab form. Gently shake the bottle to ensure mixing of mucus & transport media. Remove PPE carefully after procedure to avoid contamination. Remember to WASH HANDS. ** If immediate delivery to lab is not feasible. Keep in fridge at 4oC. Do not keep in freezer.

15 Nasal / Throat Swab Less prefer compared with NPA. Use dacron or rayon swab with plastic shafts. Do not use swab with wooden stick which contain substances that inactivate viruses and inhibit PCR testing. Place both swabs immediately into same vial of viral transport media after collection.

16 Packaging of specimens All specimens shall be collected in: a primary container a secondary container e.g. disposable and zip-lock plastic bags An outer box with a rack The container and specimen rack should be thoroughly cleansed and disinfected periodically.

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21 Sharing article Patients perceptions of NPA in the emergency department of a teaching hospital in Hong Kong ( A K C Wai & et al ) Objectives 1. Patients perception of NPA 2. Estimate the incidence of nasal bleeding after NPA

22 Outcome measure parameter Arbitrary 10-point pain scale Compare with venepuncture

23 Result Uncomfortable Mildly uncomfortable No discomfort 22(26%) 59(69%) 5(6%) 29(34%) Than venepuncture 19(22) Similar 38(44%) (P P >0.05

24 Result 5/86 (6%) nasal bleeding after NPA but none required active treatment

25 Thank You attended the workshop on Infection Control for Physiotherapists Organized by Coordinating Committee in Physiotherapy, Hospital Authority on 27 March 2007 with 3 CPD Points Granted (CPD Code: HC )