Since December 2019, SARS-CoV-2, the causative agent of COVID-19, has presented an exceptional challenge to the international medical community. As of May 20 2020, more than 12,945,828 confirmed cases of SARS-CoV-2 have been registered in at least 210 countries, with a fatality rate of approximately 4.40% (569,878/12,945,828)[1,2]. However, these numbers might be underestimated because of limited diagnostic tests and qualified professionals to perform clinical or laboratory evaluations, the presence of asymptomatic individuals who do not seek medical assistance, as well as reporting delay, misclassification and misdiagnosis of the disease [3,4]. In addition, preanalytical and analytical drawbacks, such as lack of identification or inadequate procedure for specimen collection and use of non-adequately validated assays, respectively, emerge as a significant predictor of true positive and false results.5 However, no quantitative and in-field research was performed to our knowledge[5].Therefore, considering the possible ineffectiveness of specimen collection by healthcare providers, in this study we aimed to assess the adequacy of nasopharyngeal and oropharyngeal swab collection in patients with suspected coronavirus infection in four major hospitals in Brazil. Furthermore, we aimed to evaluate the effect of update training in the performance of specimen collection by healthcare providers in a countryside city in Minas Gerais.
We performed a single-day assessment observational study in Sete Lagoas, in the State of Minas Gerais, in Southeastern Brazil. Eligible subjects were medical personnel qualified to perform swab collection from patients with suspected novel coronavirus infection. We excluded participants who work in hospital settings and do not necessarily approach suspected patients for swab collection, such as cleaners, receptionists, pharmacists, speech therapists and psychologists. Medical personnel answered an illustrated paper-based multiple-choice questionnaire on swab collection techniques. Each question had four possible answers, the correct answer being the technique recommended by the Centers for Disease Control and Prevention (Guidelines for Collecting, Handling and Testing Clinical Specimens from Persons for Coronavirus Disease 2019). There was a separate paper sheet for each swab collection type (naso- and oropharyngeal). After personnel had completed the questionnaire, one research team member provided a 40-minute training session, explaining how an appropriate collection should be performed, safety management, sample handling and storage, and basic characteristics of the disease (clinical, laboratory and radiological features). The training included an in-situ real demonstration of the correct procedures (minitip swab insertion through the nostril or mouth and target areas, as well as biosafety procedures). At the end of the training, professionals were asked to provide feedback about the intervention and the knowledge shared during the training. Chi-square tests were used to analyze proportions of correct and incorrect answers from the study. P