Rapid Antigen Testing (RAT) in Specific Clinical Settings

1 Rapid Antigen Testing (RAT) in Specific Clinical Settings Document ID CHQ-GDL-30565 Version no. Approval date 28/01/2022 Executive sponsor Executive Director Nursing Services Effective date 28/01/2022 Author/custodian Nursing Director Learning and Workforce Review date 28/01/2024 Supersedes Applicable to All Clinical Staff Authorisation Executive Director Clinical Services Purpose The purpose of this document is to provide all nursing staff inclusive of Undergraduate Students in Nursing (USINs) and approved allied health professions ( local protocol for that profession has been put in place) staff at Children s Health Queensland hospital and Health Service (CHQ) with a standardised approach and technique to carry out the collection of Rapid Antigen Test (RAT) for covid -19 respiratory screening consistent with best practice and maintain standards of patient care and safety.

2 Using a RAT will help to identify asymptomatic positive cases early and reduce transmission risk within the hospital . ALERT All approved allied health and non-registered health professionals (including students) must undertake the covid 19 Rapid Antigen Test (RAT) skills assessment prior to completing a RAT test on a patient or carer. Scope Testing for SARS-CoV-2 is central to controlling spread and managing care for patients admitted to hospital . SARS-CoV-2 PCR remains the gold standard, most sensitive diagnostic test. RATs detect protein Antigen and are less sensitive than PCR but are quick and can be performed easily at the bedside. Their best utility is when screening over time. Where the pre-test probability of a population is higher, RATs can be used as an initial diagnostic tool, particularly where PCR Testing capacity is constrained and turnaround time for PCRs has extended.

3 RATs may complement and preserve, although not replace, PCR Testing capacity. As a Point of care test (POC) its use allows for Rapid decisions about patient care to be made. In hospital , any positive result on a RAT must be confirmed by a follow-up RT-PCR test. At QCH, in hospital RATs should not be used for diagnostic, symptomatic patients where a standard or gene expert PCR is required and available. In addition, a standard RT-PCR should also be requested in many scenarios, See CHQ-GDL-60755 SARS-CoV-2 Testing and patient placement when admitted to Children s Health Queensland during the covid -19 Pandemic Period. CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 2 - - Consistent with the Public Health Act 2005; Point of Care Rapid Antigen Tests for covid -19 for Qld Public Hospitals Direction, positive results from a Rapid Antigen Test must be reported by an authorised tester.

4 Video Instructions: Nasal Mid-Turbinate (RAT) specimen collection - Pathology Queensland ( ) Oral (RAT) Specimen collection (Townsville hospital and Health Service) ALERT covid -19 tests on infants under 12 months should be carried out by an experienced clinician (RN/EN/MO/physiotherapist). Test on infants under 12 months should not be carried out by USINs AINS or other allied health professionals. Nasal Mid-Turbinate (RAT) specimen collection Procedure Test Preparation (1) Allow all kit components to reach a temperature between 15-30 C prior to Testing for 30 minutes. Figure 1: Components required to perform test (2) Don PPE and remove the test device from the foil pouch prior to use. Place on a flat, horizontal and clean surface. (3) Hold the buffer bottle vertically and fill the extraction tube with buffer fluid until it flows up to the Fill line of the extraction tube (300 l).

5 Figure 2: Filling the extraction tube with buffer fluid Caution: If the amount of buffer is excessive or insufficient, an improper test result may occur. CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 3 - - Nasal Mid-Turbinate (NMT) Specimen Collection Figure 3: How to position head and use swab (4) Tilt the patient s head back 70 degrees. While gently rotating the swab, insert swab less than one inch (about 2 cm) into nostril (until resistance is met at the turbinates). Caution: Ensure that the patient s head is kept still during nasal specimen collection, as sudden movements may cause swab stick breakage. (5) Rotate the swab five times against the nasal wall then slowly remove from the nostril. (6) Using the same swab repeat the collection procedure with the second nostril. Note: Ensure a minimum waiting period of 24 hours before performing a new nasal sampling from both nostrils ( for a repeat test).

6 ALERT If the patient has a nasogastric (NG) tube in situ, collect the specimen from the nostril without the NG tube. Caution: If the nasal swab stick breaks prior to obtaining a nasal specimen, repeat specimen collection with a new swab. If the nasal swab breaks during sampling, consultation with a medical healthcare professional is recommended to determine and initiate necessary treatment and monitoring. ALERT The use of force can cause harm to the patient s mucosal membranes and airway. If resistance is met while inserting the swab the procedure should be abandoned and a more senior clinician should assess the patient. CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 4 - - Extraction Figure 4: How to add the nasal swab into the extraction tube (7) Swirl the swab tip in the buffer fluid inside the extraction tube, pushing into the wall of the extraction tube at least five times and then squeeze out the swab by squeezing the extraction tube with your fingers.

7 (8) Break the swab at the breakpoint and close the cap of extraction tub Reaction with Test Device Figure 5: Extracting specimen onto test device (9) Open the dropping nozzle cap at the bottom of the extraction tube. (10) Dispense 5 drops of extracted specimens vertically into the specimen well (S) on the device. Do not handle or move the test device until the test is complete and ready for reading. Caution: Bubbles that occur in the extraction tube can lead to inaccurate results. If you are unable to create sufficient drops, this may be caused by clogging in the dispensing nozzle. Shake the tube gently to release the blockage until you observe free drop formation. (11) Close the nozzle and dispose of the extraction tube containing the used swab according to your local regulations and biohazard waste disposal protocol . (12) Start timer. The test takes 15 minutes to return a result and must be accurately timed using a timer (mobile phone or other).

8 Do not interpret the test result BEFORE 15 mins or AFTER 20 min of starting the test. (13) Dispose of the used device according to your local regulations and biohazard waste disposal protocol . CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 5 - - Test Interpretation Figure 6: Test Interpretation Figure 7: Dispose as per biohazard waste disposal protocol (14) Negative result: The presence of only the control line (C) and no test line (T) within the result window indicates a negative result. (15) Positive result: The presence of the test line (T) and the control line (C) within the result window, regardless of which line appears first, indicates a positive result. Caution: The presence of any test line (T), no matter how faint, indicates a positive result. (16) Invalid result: If the control line (C) is not visible within the result window after performing the test, the result is considered invalid.

9 Full test pictorial diagram Figure 8: Full test pictorial Diagram CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 6 - - Oral (RAT)_Specimen Collection Procedure Test Preparation (1) Ensure the kit is at room temperature for at least 30 mins prior to use (2) Before collecting oral fluid, ensure the patient remains Nil by Mouth for 10 mins. This includes; food, drinks, chewing gum and tobacco. (3) Gather materials Figure 9: Components required to perform oral test (4) Don PPE (5) Check the expiration date on the box. Do not use if the kit has expired. Oral (RAT) Specimen Collection (6) Ask the patient to cough into a mask 3-5 times (7) Pull the cap off gently by holding the sides to expose the collection pad Figure 10: removing the lid of the collection pad (8) Holding the top portion of the device, place the collection pad into the mouth and rub the applicator against the cheek and tongue 10 times in a circular motion (9) Leave the applicator in the patients mouth for 1-2 minutes (continuing until a line appears at the control (c)) Test Interpretation (10) Read the results between 10-15 mins (the result is not valid after 20 minutes).

10 Do not touch the device during this time. Figure 11: Timer CHQ-GDL-30565 Rapid Antigen Testing (RAT) in Specific Clinical Settings - 7 - - Test Interpretation (11) One coloured line should be in the control region (C) and another coloured line should be in the test region (T) Figure 12: positive result (12) Positive result: The presence of the test line (T) and the control line (C) within the result window, indicates a positive result. Caution: The presence of any test line (T), no matter how faint, indicates a positive result. Figure 13: negative result (13) Negative result: The presence of only the control line (C) and no test line (T) within the result window indicates a negative result. Figure 14: invalid result (14) Invalid result: If the control line (C) is not visible within the result window after performing the test, the result is considered invalid.