THROAT SWAB FOR STREP OR GONNORHEA CULTURE

Effective Date: 
Mon, 02/01/2016
Revised: 
Tue, 01/03/2017
Policy: 

RNs evaluate students presenting to the Triage Nurse with symptoms of sore throat or concerns about sexually transmitted infections.  Under this Standardized Procedure the RN may obtain a rapid strep and/or standard throat culture prior to the clinician visit.  This standardized procedure will expedite access and patient flow.  Under this standardized procedure the RN may also obtain a throat culture for gonorrhea in an asymptomatic patient who meets CDC risk criteria.

Procedure: 

Procedure

The RN making the evaluation uses the following procedure:

  • Determine the patient's chief complaint and any associated complaints
  • Take the patient's vital signs
  • Use a flashlight to examine the patient's throat
  • Use appropriate Personal Protective Equipment:  gloves and mask (optional)
    • For patient's chief complaint about asymptomatic gonorrhea in the throat the CDC recommends throat swab for gonorrhea only in men who are having oral sex with other men.  Throat culture for gonorrhea should be one part of comprehensive STI testing.  If asymptomatic students at risk present to Triage with request for throat culture for gonorrhea, the RN should obtain the throat swab and if the student has not already been tested for HIV, Syphillis, and Chlamydia and gonorrhea from urethral site, the RN should direct the student to the Self-Directed STI Testing process via the UCSC Health Center Lab.  Students at risk for rectal gonorrhea should be scheduled with a clinician.
  • For patient's with chief complaint of sore throat, obtain a throat swab for rapid strep prior to clinician exam in the following situations:
    • Any of these clinical indications:
      • Exudative pharyngitis
      • Swollen, red pharynx
      • Focal complaint of sore throat PLUS fever over 100.5
    • Per clinician instruction or preference
    • By specific request of student or family for strep testing
  • Order rapid strep test and standard throat culture in the name of the provider who will see the patient.  (The lab will cancel a standard throat culture if a rapid strep test is positive.)
  • For gonorrhea cultures not going through for clinician visit, order the culture under the Medical Director's name
  • For strep throat culture:  use a Polyester Tipped Applicator to swab the throat
  • For a gonorrhea test:  use an Aptima Genprobe culture tube and the probe provided with the kit
  • Label the specimen
  • Obtain specimen and place in appropriate transport container
  • Deliver the specimen to the lab

Experience, Training and/or Education

  • Current California RN License
  • Completion of the UCSC Student Health Center orientation specific to obtaining throat swabs

Evaluation of Competency

     Initial Competency

  •     Observes experienced clinical staff member obtaining throat swab one time
  •      Demonstrates successful use of this procedure under direct clinical staff member supervision at least 3 times.  Use HC:888 form for competency sign offs

     On-going Competency

  •      Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student   Health Center

     Scope of Supervision

  •      No direct clinician supervision
  •      Clinicians available as needed for consultation and referral

     Criteria for Provider Consultation and Referral

  •      A patient who appears severely ill or cannot open their mouth should be expedited to prompt clinician evaluation 
  •      Students who are symptomatic for a sexually transmitted infection or need education on risk reduction should be referred for a clinician visit

     Documentation

  •      RN documents according to the standards delineated in the UCSC Student Heath Center Policy on Documentation of Care