Education for COVID-19 Testing

This guide contains the mandatory education and other resources required for Regulated Health Care Providers and Unlicensed Health Care Providers to implement COVID-19 swab collection.

Specimen Collection Education: Self-Directed Learning

As per the Specimen Collection: Learning Checklist, the following information must be reviewed prior to participating in on-the-job training. Full review will take approximately 2 hours to complete. Once finished your self-directed review, please put initials, date and signature on the Specimen Collection: Learning Checklist.

Testing Care Directives

Please note, other practice settings such as Public Health Mobile Units, East Coast Forensic and Occupational Health have their own COVID -19 testing Care Directives. These can be found on the COVID-19 Hub.

Infection Control Practices

eLearning Module

You are going to complete the course "Infection Prevention and Control - Hand Hygiene". This course is available on the Nova Scotia Health Learning Management System (LMS):

COVID-19 Specimen Collection: PCR Testing

There are three different types of PCR tests available at NS Health. Use proper technique when collecting any specimen for COVID-19 testing. A poorly collected specimen is likely to lead to a false negative result. A missed person with COVID-19 puts everyone at risk. For the PCR test for diagnosis, the preferred sample type for adults who are symptomatic, asymptomatic, pre-procedure, pre-admission or an in-patient is the Nasopharyngeal swab. The throat/nares (i.e., OP/Nares) is the less preferable route, but can be used if an NP swab is contraindicated. Saline gargle testing is available for children 4 to 18 only, and there are times where an NP swab is preferred. The Care Directives are the most reliable, up-to-date source of which collection method is appropriate.

Please review: Nasopharyngeal Swab Collection

Please review: Throat/Nares Swab Collection

 

COVID-19 Specimen Collection: POCT

Lucira

The Lucira Check It test is a molecular rapid point-of-care test for the detection of SARS-CoV-2 (the causative agent of COVID-19), using loop-mediated isothermal amplification (LAMP) technology. It is a battery-operated device that performs a LAMP reaction on a patient’s bilateral nasal sample, and gives a qualitative result on the basis of automated detection of viral RNA. It is more sensitive than antigen-based POCTs, and preliminary data suggests a sensitivity approaching that of lab-based PCR (though further data are being collected).

The test can be performed with minimal training and at the point of sample collection. The test also provides a fast turn around time (10-30 minutes), allowing the result to be acted on more quickly than RT-PCR. It is to be used in limited settings as approved by Microbiology at Nova Scotia Health and IWK Health Centre, the Covid Network, and Public Health. A positive result must be confirmed with a new swab for PCR. A negative result cannot be used to definitively rule out infection with SARS-CoV-2.

Please review:

Positive POC Test

If POCT is positive, follow the steps outlined in the care directive, SOP and/or as per local processes.

The following information can be provided to the person who tests positive with a POCT at a COVID-19 Testing Centre, who is then testing using PCR (for confirmation).

  • Results of PCR test will be shared either by email, if one was provided, or a call from Public Health
  • Patients would be required to self-isolate until results received
  • Patient information handouts for self-isolation can be shared:

Pediatric Considerations

  • Regulated health care providers must collect COVID-19 specimens on infants and children, ages 0-3.
  • Unlicensed health care providers collect COVID-19 specimens on children and youth, ages 4-18.

It is always helpful to check in with the parents to see what they think of how their child is doing.

Nasopharyngeal Swab Collection for Children

COVID-19 test video for children to watch

BC Children's Hospital, Provincial Health Services Authority (PHSA), 2020.

COVID-19 Specimen Collection: PCR Saline Gargle

The preferred method of COVID-19 testing in children and youth ages 4 to 18 is the swish and gargle method. It has been validated by Nova Scotia Health as an effective COVID-19 testing method for this population group only. This new method is easier, less painful and invasive for children and youth. For children from ages 0 to 3, those who are unable to do the gargle test, or for pre-surgery/procedure, the preferred sample method remains swab collection via the nasopharyngeal route.

Gargle

Children or youth 4-18 years old may be able to have the gargle test if able to:

  • swish salty water in the mouth for 5 seconds, then
  • gargle with the salty water for 5 seconds, and repeat both steps 2 more times (total time of 30 seconds), then
  • spit the salty water into a container

The Care Directive lists all the contraindications that regulated health care providers must assess for prior to the gargle test. If a child or youth has a contraindication for gargle, the preferred route for COVID-19 testing is swab collection via the nasopharyngeal route. The biggest safety risk to a child or youth is aspiration into the lungs, related to inability to swish and gargle. Swallowing the solution is safe, as it is only 0.9% saline. If a child or youth attempts the gargle test and is unsuccessful (e.g. swallows solution, cannot swish/gargle, spits out too quickly), do not re-attempt the test via the gargle route. An NP swab must be obtained instead.

Younger children do best when they practise the steps at home with water; just make sure that practice is at least two hours before the test. Children/youth must not: eat, drink, chew gum, brush teeth, smoke or vape for at least one hour before the test. It is extremely important that children and youth who are using the gargle testing method follow these guidelines, as failure to do so may affect the accuracy and usability of the COVID-19 test.

During the procedure, the child and youth must wear their mask while swishing and gargling, to decrease risk of aerosolizing COVID-19 particles. Care providers wear the same personal protective equipment as per other routes of COVID-19 specimen collection. Care providers, parents or guardians can assist the child with pouring the saline into their mouths, or with holding the container while they spit.

Regulated health care providers who have completed the education and training for gargle can perform the test.
Unlicensed health care providers can perform the Gargle test on children between 4 and 18 years of age ONLY, and only after completing education and training.

Gargle Instructions

Nova Scotia Health, 2020.

Kids Swish and Gargle Test Video

Nova Scotia Health, 2021.

On-the-Job Training: Specimen Collection Checklists for Regulated Health Care Providers

On-the-Job Training: Specimen Collection Checklists for Unlicensed Health Care Providers

As per the COVID-19 Specimen Collection: Learning Checklist, UHCPs must participate in educational sessions with Interprofessional Practice and Learning, and Infection Prevention and Control. Following these sessions, UHCPs must successfully demonstrate three swab collections for throat/nares, three swab collections for nasopharyngeal, and two gargle tests. This will occur under preceptor supervision, prior to independently practicing these skills. If only one type of swab is used in the practice setting due to supply, then it is not necessary to be trained in other swab collection route. This will be completed in one 7.5 hour preceptored shift. The preceptor must be a care provider who is competent in specimen collection in that practice setting. The preceptor and UHCP complete the skills checklist.

Once all self-directed learning and preceptorship is complete, it is the responsibility of the UHCP to submit completed learning checklists and skills checklist to clinical leadership.