Unacceptable Specimen Containers

Because of the limited stability of unpreserved urine for gonorrhea, chlamydia, and trichomoniasis testing, Cleveland Clinic Laboratories is currently unable to accept urine in a sterile container (i.e., specimen cup) for UGCCT and TRVAMP orders.

Test Name

Coronavirus 2019 (COVID)

Turnaround Time

24 hours from the time of receipt by the laboratory*
Testing is performed 24 hours a day, 7 days a week

Specimen Requirements

Type:
(1) Nasopharyngeal (NP) Swab – preferred 

Volume:
3 mL

Specimen Container:
Universal Transport Media (UTM)

Transport Temperature:
Refrigerated; transport to the laboratories on cold packs or wet ice.

Alternative

Type:
(1) Nasopharyngeal (NP) swab, or
(1) Nasal (anterior nares) swab

Volume:
3 mL

Specimen Container:
Saline transport medium

Transport Temperature:
Refrigerated; transport to the laboratories on cold packs or wet ice.

Alternative

Type:
(1) Oropharyngeal (OP) Swab

Volume:
3 mL

Specimen Container:
Regular Tip Flocked Swab in Universal Transport Media (UTM)

Transport Temperature:
Refrigerated; transport to the laboratories on cold packs or wet ice.

Alternative

Type:
Lower respiratory specimens: sputum or bronchoalveolar lavage (BAL)

Volume:
3 mL

Specimen Container:
Sterile specimen container

Transport Temperature:
Refrigerated; transport to the laboratories on cold packs or wet ice.

Stability

Ambient:
Unacceptable

Refrigerated (2-8ºC):
72 hours

Frozen:
Up to 30 days

Rejection Criteria

Unacceptable:

Test Name

Routine COVID with Flu A+B (COVFLU) 

Routine Flu & RSV Testing (RTFRSV)

Turnaround Time

24 hours from the time of receipt by the laboratory

Specimen Type

Type:
(1) Nasopharyngeal (NP) Swab – preferred, or
(1) Anterior nasal swab, or
(1) Midturbinate swab

Universal Transport Media
(UTM), 3 mL

Viral Transport Media
(VTM), 3 mL

Saline Transport Media,
3 mL

eSwab Liquid Amies Transport
Media, 3 mL

Stability

Ambient:
Unacceptable

Refrigerated (2-8ºC):
72 hours

Frozen:
Up to 30 days

Transport Temperature

Refrigerated. Transport to the laboratories on cold packs or wet ice. 

Patient Demographics & Reporting

Due to mandatory reporting for COVID-19 testing, additional patient demographic information is needed to complete a test order.

Failure to provide the required information will result in delayed testing.

Cleveland Clinic will report positive test results to the Ohio Department of Health (ODH).

Patient Details

• First & last name
  • Guardian’s name (for patients 16 years old and under only)
• Date of birth
• Sex
• Race/ethnicity
• Current address (street, city, county, state, zip code)
• Primary telephone number (please include area code)
• Insurance details

Specimen Details

• Collection date
• Collection time
• First & last name of the collector
• Specimen type (e.g., NP swab, sputum)

Healthcare Provider Details

• First & last name
• Address (street, city, county, state, zip code)
• Phone number

1. Is the patient being tested for COVID-19 for the first time?

2. Are they employed in health care?

3. Is the patient symptomatic as defined by CDC? (If yes, please indicate Date of Symptom onset)

4. Are they currently hospitalized?

5. Are they currently admitted to an ICU?

6. Is the patient a resident in a congregate care setting (e.g., nursing home, residential care for people with intellectual and developmental disabilities, psychiatric treatment facility, group home, board & care home, homeless shelter, foster care, or other setting)?

7. Is the patient pregnant?

You will need:

• Personal protective equipment (PPE)

• (1) tube of transport medium

– Universal Transport Media (UTM)
– Viral Transport Media (VTM)*
– Saline solution

• (1) swab

• Patient identification labels

Before you begin:

• Confirm the patient’s name and date of birth.

• Wash your hands, then put on personal protective equipment, including gloves.

Step 1:
Carefully remove the swab from the packaging without touching the tip.

Step 2a – for nasopharyngeal (NP) swabs:

– Gently insert the NP swab along the nasal septum just above the floor of the passage to the nasopharynx until resistance is met.

– Rotate the swab gently against the nasopharyngeal mucosa for 10 – 15 seconds, then remove.

Step 2b – for oropharyngeal (OP) swabs:

– Insert the OP swab into the back of the patient’s throat and gently swab the tonsillar pillars and posterior oropharynx.

Step 3:
Remove the cap from the tube, then insert the swab all the way to the bottom of the vial.

Step 4:
While holding the tube away from your face, bend the swab in the vial at a 180-degree angle to break at the marked breakpoint.

Step 5:
Close the tube tightly. If possible, wrap the cap with Parafilm.

Step 6:
Label specimen with the printed label or write the patient’s first & last name, date of birth, and the date, time, and site of collection (e.g., NP or OP) on the tube.

Step 7:
Double-bag the specimen, place on wet ice, then refrigerate.

Step 8:
Complete a Coronavirus 2019 (COVID) Test Requisition.

Step 9:
Place the completed requisition in the pocket of the specimen bag.

Step 10:
For the fastest turnaround time, deliver the specimen directly to the Main Campus LL Building Specimen Receiving Area:

Cleveland Clinic Laboratories
10300 Carnegie Avenue
Cleveland, OH 44106

Nasal (Anterior Nares) Swabs

Step 1:Carefully remove the swab from the packaging without touching the tip.

Step 2:

Position the patient’s head slightly back, then insert the swab into their LEFT nostril (less than one inch) and gently push until a slight resistance is met.

Step 3:

Rotate the swab against the inside of the patient’s nostril four times for 10-15 seconds.

Step 4:
Remove the swab, then repeat Steps 2 & 3 in the RIGHT nostril with the same swab.

Remove the swab from the patient’s nose when finished.

Step 5:

While holding the swab, open the tube and set the cap down with the threads facing up.

Insert the swab into the tube until the breakpoint is level with the tube opening.

Step 6:

While holding the tube away from your face, bend the swab until it snaps at the break point.

Step 7:

After discarding the remaining swab shaft into an approved disposal container, screw the cap back onto the tube.

Apply the test label or write the patient’s information onto the tube.

Step 8:

Place the specimen into a biohazard bag, then insert any lab paperwork into the outside pouch.

Due to incompatibilities with COVID-19 testing laboratory equipment, specimens in Beaver Biomedical VTM or NEST Solution for Sample Collection, Transport, and Storage are not acceptable for COVID-19 testing performed by CCL.