The Evolving Role of Nasal Lavage

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Improving Patient Safety and Specimen Quality for Today’s URI Testing

By Michael C. Wadman, MD, FACEP

Upper respiratory infections (URI), from the flu and RSV to emerging viral threats, continue to challenge healthcare systems year after year. As testing remains our first line of defense in both routine care and outbreak response, the need for highly sensitive, patient-friendly specimen collection methods continues to increase.

While nasal swabs have traditionally filled this need, new advancements in nasal lavage are shifting the landscape. It is interesting to note that URI nasal lavage sampling was used prior to the COVID-19 pandemic, but today’s evolved solutions offer a safe, consistent, and comfortable alternative.

For URI testing in the post-pandemic world and in preparation for the next outbreak, whether it is weeks, years or decades away, improving specimen collection systems remains an important focus. Evolved nasal lavage is a practical, scalable innovation that’s already making an impact. Here’s how.

Why swabs became the default, but not the ideal

The widespread use of nasal swabs during COVID-19 was born out of urgency and necessity. Existing supply chains, manufacturing capacity, and training protocols allowed healthcare systems to quickly deploy swab-based specimen collection worldwide.

However, haphazard adoption masked several underlying limitations that became evident as testing volumes surged. Unlike nasal lavage, swab-based collection requires inserting a long shaft 4 to 6 inches into the nasopharynx—a highly sensitive region near the skull base.

The procedure also demands precise angling, depth control, and rotation to collect an adequate sample, making consistent technique difficult to achieve across diverse care settings.

Inconsistent collection often resulted in reduced sample sensitivity and significant false negative rates, particularly in asymptomatic and early-stage patients.

Meanwhile, poor patient experiences made public acceptance rates plummet. According to a U.S. survey of 2,000 respondents weighing sample collection options:

Evolving nasal lavage for safer collection and more sensitive samples

Evolved nasal lavage approaches have reintroduced the sampling method as a superior alternative for URI specimen collection. Rather than physically scraping mucosal surfaces to obtain cells, nasal lavage uses a gentle rinse-and-capture mechanism. The procedure flushes sterile saline through the nasal cavity, naturally collecting epithelial cells and viral particles.

This approach offers several patient safety advantages over traditional swabs:

  • Reduced injury risk: Because lavage does not require deep insertion, it eliminates risks associated with nasopharyngeal trauma, including nasal bleeding, mucosal abrasion, and rare complications such as cerebrospinal fluid leaks.
  • Fewer involuntary reactions: The less-invasive method minimizes flinching, jerking, and gagging, which can compromise sample adequacy and put patients at risk.
  • Greater comfort: Nasal lavage is generally better tolerated across diverse patient populations, especially children, older adults, and individuals with heightened gag reflexes or anatomical challenges. Less anxiety leads to more public compliance.

Higher quality specimens = fewer false negatives

The benefits of nasal lavage extend beyond patient comfort, capturing cellular material from the entire upper respiratory tract for more comprehensive sampling. In comparative studies, nasal washes have identified 88% of infected patients, compared to 77% with swabs.

This broader capture range leads to higher viral loads in collected specimens, allowing molecular tests such as PCR to detect infections earlier and with greater sensitivity. The Annals of Internal Medicine reports that nasal swabs, even when paired with highly sensitive PCR tests, have demonstrated false negative rates of up to 20% a whole three days after symptom onset.

In contrast, evolved nasal lavage reduces false negatives to near zero when combined with PCR, significantly improving diagnostic confidence during the narrow treatment window when antiviral therapies are most effective.

Higher cellular yield also supports multi-pathogen testing, allowing laboratories to simultaneously screen for several viral and bacterial pathogens—including COVID-19, influenza, and RSV—with a significantly greater PCR sensitivity compared to nasal swab samples.

Increased lab efficiency and future testing scalability

Nasal lavage solutions may also help address long standing operational challenges in the lab. Swab-based samples require manual extraction procedures prone to errors, clogged extraction needles or pipette tips, and exposure to infectious material for lab personnel.

Nasal lavage samples, however, produce highly consistent specimens compatible with existing laboratory processes. Smooth integration reduces the need for labor-intensive manual processing and enables faster turnaround—particularly critical when managing high testing volumes during outbreaks. Furthermore, fewer inconclusive results minimize diagnosis delays and reduce overall laboratory costs.

From a logistical perspective, some lavage devices offer shelf lives exceeding three years, making them more practical for stockpiling and long-term pandemic preparedness. Comparatively, swab kits often expire within one to two years, creating unnecessary waste and supply chain pressure.

Building a stronger diagnostic future

COVID-19 illuminated both the strengths and limitations of current testing infrastructures. While nasal swabs played a key role in enabling rapid global response, they were never meant to serve as the long-term gold standard for URI sampling.

Evolved nasal lavage solutions—made possible by advances in device design, usability, and laboratory integration—offer a path forward that better aligns with patient safety and specimen quality initiatives.

  • For patients: These advancements translate to more comfortable, less invasive testing experiences.
  • For providers and laboratories: They support more consistent sample quality, earlier and more accurate diagnoses, and improved clinical outcomes.
  • For public health leaders: They offer a scalable tool that can be rapidly deployed in response to future outbreaks, whether seasonal or pandemic.

As global healthcare systems continue fine-tuning outbreak response and clinical preparedness, integrating safer and more reliable specimen collection methods will remain a priority. With evolved nasal lavage solutions gaining popularity, healthcare providers now have an alternative collection method that closely aligns with the accuracy and efficiency standards today’s diagnostic technologies demand.

Michael C. Wadman, MD, FACEP, is Chief Medical Officer of University Medical Devices, the developer of the MicroWash nasal lavage system. A veteran emergency physician, Dr. Wadman also holds tenured professor and endowed chair positions at University of Nebraska Medical Center.