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New style for nasopharyngeal swab with a mask: image-evaluation

  • Author Footnotes
    ⁎ All authors contributed equally.
    Kazuomi Takahashi
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    ⁎ All authors contributed equally.
    Affiliations
    Respiratory Medicine, Nagoya University Graduate School of Medicine
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  • Author Footnotes
    ⁎ All authors contributed equally.
    Shotaro Okachi
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    ⁎ All authors contributed equally.
    Affiliations
    Respiratory Medicine, Nagoya University Graduate School of Medicine
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  • Author Footnotes
    ⁎ All authors contributed equally.
    Hirotoshi Yasui
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    ⁎ All authors contributed equally.
    Affiliations
    Respiratory Medicine, Nagoya University Graduate School of Medicine
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  • Author Footnotes
    ⁎ All authors contributed equally.
    Shunichi Taki
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    ⁎ All authors contributed equally.
    Affiliations
    Respiratory Medicine, Nagoya University Graduate School of Medicine
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  • Author Footnotes
    ⁎ All authors contributed equally.
    Takayasu Ito
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    Respiratory Medicine, Nagoya University Graduate School of Medicine
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    Noriaki Fukatsu
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    Affiliations
    Nagoya University Institute for Advanced Research, Advanced Analytical and Diagnostic Imaging Center (AADIC) / Medical Engineering Unit (MEU), B3 Unit
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  • Kazuhide Sato
    Correspondence
    Correspondence should be addressed to: Kazuhide Sato, M.D., Ph.D. Institute for Advanced Research, S-YLC, Department of Respiratory Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, 466-8550, Japan, Phone: +81-052-744-2167; Fax: +81-052-744-2176.
    Affiliations
    Respiratory Medicine, Nagoya University Graduate School of Medicine

    Nagoya University Institute for Advanced Research, Advanced Analytical and Diagnostic Imaging Center (AADIC) / Medical Engineering Unit (MEU), B3 Unit

    FOREST-Souhatsu, CREST, JST

    Nagoya University Institute for Advanced Research, S-YLC
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Open AccessPublished:June 21, 2021DOI:https://doi.org/10.1016/j.ijid.2021.06.039
      COVID-19, caused by SARS-CoV-2, is rapidly spreading worldwide and has become a threat to humankind. Respiratory infectious viruses such as SARS-CoV-2 are transmitted via contact and droplets and have a high secondary attack rate ranging from 3.0%–11.2% in households (
      • Wiersinga WJ
      • Rhodes A
      • Cheng AC
      • Peacock SJ
      • Prescott HC.
      Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
      ). Diagnosis of respiratory infectious virus is performed by collecting specimens from the surface of the respiratory mucosa using nasopharyngeal swabs (
      • Föh B
      • Borsche M
      • Balck A
      • Taube S
      • Rupp J
      • Klein C
      • et al.
      Complications of nasal and pharyngeal swabs - a relevant challenge of the COVID-19 pandemic?.
      ;
      • Marty FM
      • Chen K
      • Verrill KA.
      How to Obtain a Nasopharyngeal Swab Specimen.
      ). However, it is a high-risk procedure for healthcare workers because it causes pharyngeal reflexes or sneezing. We have developed a new mask that patients can wear when undergoing nasopharyngeal swab collection to reduce the infectious risk for healthcare workers. The mask was originally developed for use in endoscopy. It has a 10-mm-slit in the center to insert the bronchoscope and a 6-mm-slit on both sides for the suction catheter (Figure 1A). The patient (the mannequin) wore this mask slightly above the usual level, and the examiner inserted a pharyngeal swab through the 10-mm hole (Figure 1B). This method is thought to be effective in preventing airborne droplets exposure. We evaluated the protective effect of the mask using a highly sensitive camera and a high-power light source (ViEST system) that can visualize airborne particles over 80 nm in size, and visually confirmed the protective effect of the mask (Figure 1C and supplementary video). Moreover, for the precise evaluation of the protective effect with the mask, we did the visualization 3 times. Quantification of the pixels of airborne particles from the visualizations indicated significant reduction of airborne particles with the mask (P = 0.0132 < 0.05, Student's t-test). This mask has several other advantages. First, the patient does not feel uncomfortable while wearing this mask because its basic structure is similar to that of surgical masks. Second, it is disposable and thus contributes to the prevention of sample contamination. However, there is a concern that because the mask inhibits the visualization of the proper swab collection, the swab collector would have to be trained.
      Figure 1
      Figure 1(A) Scheme of a mask for nasopharyngeal swab (left). The mask had a 10-mm-slit in the center for swab stick insertion and a 6-mm-slit on both sides for the suction tube (right).
      (B) The appearance of the swab-test-mannequin with or without the mask (left and center pictures). Nasopharyngeal swab can easily insert through the slit (right picture).
      (C) High-speed sensitive camera images (ViEST system) of splashes during coughing without and with the swab mask (See Supplementary Video 1). The mask can prevent splashes and droplets.
      In conclusion, this mask is a valuable and straightforward protective tool. The use of this mask by patients, together with conventional infection prevention measures, has preventative benefits during nasopharyngeal swab collection.

      Declaration of Competing Interest

      S.O., H.Y., and K.S. have a patent pending.

      Funding Source

      This research was supported by the Nagoya University Dean fund for B3, Yahoo Japan kikin for COVID-19 and KAKEN (grant numbers 18K15923 and 21K07217) (JSPS), CREST (JPMJCR19H2, JST) and FOREST-Souhatsu (JST) to K.S. Funders only provided funding, and had no role in the study design, data collection, data analysis, interpretation, and writing of the report.

      Author Contributions

      All authors are equally contributed to this work. K.T., S.O., H.Y., T.I., and K.S. conducted the experiment and wrote the manuscript, N.F. and S.T., performed image analysis. K.S. supervised, designed, conceived, and conducted the project.

      Ethical Approval

      The research protocol was reviewed and approved by the Ethics Committee of the Nagoya University Clinical Research Committee (Approval No. 2020-0127). This article does not contain any studies with human participants performed by any of the authors.

      Consent

      Not applicable.

      Availability of data and materials

      Not applicable.

      Acknowledgments

      We thank Mr. Akinori Terazawa and Mr. Takanao Yokoi in Shirohao Co. Ltd. for industrial mask production. We also thank Mr. Ryuta Okamoto and Kozo Takahashi for the ViEST System and Mr. Kazuhiko Kogo and Ms. Nahoko Sakaguchi, Nagoya University URA.

      Appendix. Supplementary materials

      References

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        • Borsche M
        • Balck A
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        • Rupp J
        • Klein C
        • et al.
        Complications of nasal and pharyngeal swabs - a relevant challenge of the COVID-19 pandemic?.
        Eur Respir J. 2020;
        • Marty FM
        • Chen K
        • Verrill KA.
        How to Obtain a Nasopharyngeal Swab Specimen.
        N Engl J Med. 2020; 382: e76
        • Wiersinga WJ
        • Rhodes A
        • Cheng AC
        • Peacock SJ
        • Prescott HC.
        Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
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