What are the guidelines and precautions for a buccal (bucal) scraping procedure?

Buccal Scraping Procedure: Guidelines and Precautions

Buccal scraping is a minimally invasive procedure that requires standard infection control precautions including gloves for all patient contact, with additional PPE (protective eyewear, mask, and gown) when spattering of blood or body fluids is likely. 1, 2

Personal Protective Equipment Requirements

• Wear gloves for all patient interactions during buccal scraping procedures 1, 2
• Use protective eyewear, mask, and gown when spattering of blood or other body fluids is anticipated 1, 2
• For surgical oral procedures requiring buccal tissue collection, perform surgical hand antisepsis using an antimicrobial product before donning sterile surgeon's gloves 1, 2

Specimen Collection Technique

Standard Buccal Scraping Method

• Use a soft sterile brush (bronchial brush) or small disposable plastic cup (Rhinoprobe) in the buccal mucosa, which is more comfortable and accurate than swabbing 1
• A blunt sterile spatula can be used to scrape cells from the buccal epithelium 3
• The Rhinoprobe technique is preferred as it provides better patient comfort and specimen accuracy compared to traditional swabbing 1

Alternative Collection Methods

• Nasal brushing techniques can be adapted for oral use, involving gentle brushing followed by placement in tubes containing appropriate growth medium 1
• Material should be dislodged by oscillation and centrifuged at 400 g for 10 minutes to obtain cellular specimens 1

Specimen Handling and Transport

• Place specimens in a sturdy, leakproof container labeled with the biohazard symbol during transport 1, 2
• If the specimen container becomes visibly contaminated, clean and disinfect the outside or place it in an impervious bag labeled with the biohazard symbol 1, 2
• Specimens can be immediately frozen at -80 to -90°C before further processing to prevent proteolysis 1

Infection Control Measures

Equipment Sterilization

• Use single-use devices for one patient only and dispose of them appropriately 1
• Heat-sterilize reusable instruments between patients according to manufacturer's instructions 1
• Do not surface-disinfect or use liquid chemical sterilants on instruments that can be heat-sterilized 1

Medication Administration (if applicable)

• Do not administer medication from a syringe to multiple patients, even if the needle is changed 1, 2
• Use single-dose vials for parenteral medications when possible 1, 2
• Cleanse multidose vial access diaphragms with 70% alcohol before inserting a device 1, 2
• Keep multidose vials away from the immediate patient treatment area to prevent contamination by spray or spatter 1, 2

Clinical Applications and Considerations

Diagnostic Uses

• Buccal mucosal scrapings can be used for sex determination through Barr body identification using Papanicolaou staining 4
• Gene expression analysis can be performed on buccal cells, as demonstrated in burn patients where nicotinic acetylcholine receptor genes were successfully analyzed 5
• This minimally invasive method obviates the need for more invasive tissue sampling procedures 5

Patient Assessment

• Assess for signs of gingival infection or oral pathology before performing the procedure 2
• Evaluate for respiratory distress or airway compromise if oral swelling or infection is present 2, 6
• Examine the oral cavity after cleansing with water or saline to accurately assess tissue condition 6

Common Pitfalls to Avoid

• Inadequate infection control practices can lead to cross-contamination between patients 2
• Failure to use appropriate PPE when body fluid exposure is possible 1, 2
• Reusing single-use devices or improperly sterilizing reusable instruments 1
• Improper specimen labeling or transport that compromises diagnostic accuracy 1, 2
• Collecting specimens from inflamed or infected areas without proper precautions 2, 6

Post-Procedure Care

• Instruct patients on warning signs requiring immediate medical attention, including increasing swelling or difficulty breathing/swallowing 2, 6
• Recommend warm saline rinses to promote healing and reduce inflammation if tissue irritation occurs 2, 6
• Advise maintaining good oral hygiene with gentle brushing using a soft toothbrush 6