Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial

Abstract

Background: Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP.

Methods: The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction.

Results: Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001).

Conclusions: In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.

Trial registration: ClinicalTrials.gov NCT01249625.

Keywords: Diagnostics; Feasibility; Influenza; Self-collection; Surveillance.

Fig 1

Ratio of pathogens by collection method. (A) Relative proportion of research assistant-obtained (RA) and self-collected (take-home kits, THK) total symptomatic samples collected (left panel) and total positive symptomatic samples (right panel). (B) Relative proportion of positive and negative samples from swabs collected (top panels) and distribution of identified pathogens from positive samples (bottom panels) for all self-collected (THK) swabs (black), RA-obtained swabs (dark gray), and all swabs collected (light grey).