Development of drive-through and mailin systems for obtaining surveillance respiratory specimens in a pediatric cystic fibrosis center

Introduction: Routine surveillance cultures are an essential part of health maintenance for people with cystic fibrosis (CF) Sputum and deep-pharyngeal swab specimens are used for surveillance The Cystic Fibrosis Foundation recommends that respiratory cultures be obtained every three months The CF Care Center at Children's Mercy Kansas City (CMKC) also obtains respiratory cultures when there is an acute change in respiratory symptoms The COVID-19 pandemic resulted in ambulatory clinic closures, increased telemedicine visits, and an inability to obtain surveillance respiratory cultures A creative solution for obtaining respiratory cultures was needed during the pandemic Methods: CMKC developed a drive-through respiratory specimen collection process The target population was CMKC patients who were due for a culture and lived within an hour of the Kansas City metropolitan area (N= 96) A drive-through service was operated one day a week for 2 hours Families were contacted and scheduled for a specific appointment time Specimens were obtained in a drive-through parking lot, eliminating exposure of patients and staff to groups of people The drivethrough service was staffed by one nurse and one respiratory therapist Staff donned gown, gloves and mask per Cystic Fibrosis Foundation and CMKC COVID-19 guidelines Specimens were delivered to the microbiology laboratory between collections A pilot with six specimens was completed the first week and then was increased to twelve the following week People with CF who were unable to attend the drive-through culture service were offered the option to provide a mail-in sputum specimen Eligible patients were identified and educated regarding the process and a sputum collection kit with detailed instructions was sent to family Specimens were returned in a cooler with frozen ice pack via FedEx and were routed directly to the microbiology lab for processing Results: The drive-through culture collection service started on April 22, 2020 It will be offered for the foreseeable future To date, the drivethrough culture collection service has been offered once a week for 7 weeks Of 96 eligible patients, 47 have participated In four instances a patient was found to have a new emergence of a respiratory pathogen that warranted a change in management The mail-in sputum specimen service started on May 1, 2020 Two patients have participated to date Twenty-one percent of CMKC CF patient population obtained a routine surveillance culture during the timeline of the project using one of these two methods People with CF and their caregivers provided positive feedback regarding the experience Fourteen families did decline to attend the drive-through culture service, many not wishing to drive to Kansas City Some families preferred to wait until their child could be seen in person as they perceived them to be doing well Conclusions: The development of drive-through and mail-in culture systems allowed CMKC to obtain essential surveillance data during the COVID-19 pandemic Limitations of this project included a lack of ability to obtain pharyngeal swabs/specimens for people with CF living outside of the Kansas City metropolitan area