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Optimizing oropharyngeal swabbing techniques: the relationship between force applied and SARS-CoV-2 detection
Peter Melcher1,2, Corinna Pietsch3, Sandra Bergs3
1Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany.
GMS Hygiene and Infection Control
|May 12, 2025
Summary
Applying greater force during oropharyngeal swab collection for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) testing increases cell count but does not improve nucleic acid test sensitivity, potentially worsening results.
Area of Science:
- Medical Diagnostics
- Virology
- Preanalytical Factors in Testing
Background:
- Nasopharyngeal and oropharyngeal swabs are critical for diagnosing SARS-CoV-2 infections.
- Nucleic acid testing (NAT) is the most sensitive diagnostic method for SARS-CoV-2.
- Preanalytical factors, particularly sample quality, significantly impact NAT accuracy.
Purpose of the Study:
- To investigate the influence of applied force during oropharyngeal sampling on sample quality.
- To assess the relationship between sampling force, cell count, and SARS-CoV-2 NAT cycle threshold (Ct) values.
Main Methods:
- A three-phase study was conducted.
- Examined the correlation between sampling force and cellular yield.
- Assessed the impact of cell count on NAT sensitivity (Ct values).
Main Results:
- Artificially increasing cell count led to significantly lower Ct values.
- Greater applied force during sampling resulted in higher cell counts.
- However, increased force showed an inverse correlation with SARS-CoV-2 NAT sensitivity (higher Ct values).
Conclusions:
- Increased force during oropharyngeal sampling yields more cells but does not enhance SARS-CoV-2 NAT sensitivity.
- Excessive force may negatively impact diagnostic accuracy.
- Future research should explore optimizing swab design to improve sample quality and cellular yield for better diagnostic outcomes.
