Microbiology

Our microbiology laboratory is situated at Worcestershire Royal Hospital.

It provides a diagnostic service for bacteriology and virology as well as maintaining links with outside bodies such as Public Health England, involved in monitoring patterns of infection in the community. 

A proportion of the routine serological analytical processing is undertaken by the clinical biochemistry department; however responsibility for reporting and quality assurance remains with the microbiology service. 

Who's who and contact details

Microbiology 

Microbiology lab locations and opening hours

Tests available

• Microbiology tests
• Microbiology - environmental tests
• Microbiology - referred samples
• Microbiology - virology

Clinical advice and interpretation of results

We are a small team and always do our best to answer your clinical advice requests in a timely manner. Due to increasing demands on our time from both within and outside of the acute trust we are not always able to answer your calls immediately but will call you back if you leave your details and that of the patient you would like to discuss.

During office hours (9am-5pm Monday to Friday):

• Please contact the 1^st or 2^nd on duty microbiologists via the contact numbers above.

• Routine calls should be restricted to 10am-12pm & 2pm-4pm (3-4pm on Mondays) to allow for ward rounds and MDT commitments.

• Clinically pressing calls will be taken outside of this time between 9am-5pm

Out of office hours (Weekends and 5pm-9am weeknights)

• The on call Consultant Microbiologist is available via Switchboard for urgent clinical calls.

• Call only if urgent discussion is required or a new clinically urgent issue has developed.

• The on-call Consultant may not your local Microbiologist and will not have access to microbiology results.

Guide for calling Microbiology for clinical advice:

• For Medical Staff: Calls will only be taken from registrar grades and above (unless the team does not have a registrar in which case calls will be taken from Junior team members.

• For Nursing staff: Calls will only be taken from ward managers and above. After 11pm from Duty Bleep holder.

• Pharmacy calls should be directed to the Antibiotic Pharmacist in the first instance.

• Please try and make your routine calls earlier in the day. Routine calls from Hospital clinical teams should not be left to after 4pm.

When calling for clinical microbiology advice it is essential that the following information is provided by the caller. Without this it is impossible to give high quality and safe advice:

Please refer to microbiology reports and clinical advice records on ICE before calling the Consultant Microbiologist as the advice may answer your question.

• Name, date of birth, hospital number and current location of patient

• Date of admission and working diagnosis

• Brief relevant clinical history (including NEWS score/current observations)

• Any relevant diagnostic results e.g. WCC, CRP, imaging

• The dose and duration of current and previous antibiotics (including pre-admission).

• If allergic to penicillin, more information on the nature of the allergic reaction.

• Please check the intranet guidance before calling for advice regarding gentamicin and vancomycin levels (this will usually provide the advice required).
  

On-call (out of hours emergencies)

A countywide emergency on-call service operates out of hours. 

This service is available for:

• Cerebrospinal fluid (CSF)
• Joint aspirate, ascitic fluid and aspirates from deep abscesses
• Specimens collected in operating theatres from body sites otherwise inaccessible, eg peritoneal or liver abscesses.
• Paediatric urine
• HIV requests for high risk mothers in labour (by arrangement with duty Consultant Microbiologist)

Specimens other than those identified above will not be examined unless by prior agreement with the duty Consultant Microbiologist via switchboard.
 

Acceptance and Rejection Criteria of Pathology Samples 

1.     Minimum Acceptable Patient Identification Criteria for Samples and Request Forms

Stringent procedures, informed by guidance from professional bodies, for the receipt of samples and request forms exist to ensure the safety of the patient (to ensure that the right investigation(s) is performed on the right sample(s) and the results assigned to the correct patient).

The responsibility for requesting a laboratory service/test lies with an authorised practitioner (normally a clinician). It is the responsibility of the requester to ensure that samples are correctly labelled and request forms completed to the agreed standard. Before accepting a clinical specimen, laboratory staff competent in this task must ensure certain minimum criteria for sample identification are met.

To ensure the unequivocal identification of patient and sample certain information is required on all request forms and samples. Sample and request form information mustbe compatible:

** Note : For patients who have been allocated a unique coded identifier for confidentially purposes (e.g. Sexual Health Clinic patients), the NHS number should not be quoted.

DO NOT Package the request forms in the sample transport bag with the specimen.

Packaging the request form inside the transport bag can obscure the sample from view, this could lead to an error in sample sorting and may obscure a possible leakage from view. It is imperative for the health and safety of the laboratory that the request form is attached to the outside of the sample bag as seen below.

CORRECT PACKAGING:

This is the correct method for packaging samples for the Microbiology department

It is preferable for information on all samples to be handwritten for the following reasons:

· To reduce the risk of the wrong label being attached.

· Printed patient labels on blood tubes obscure the sample contents and may have to be removed prior to serum separation.

· Printed labels can cause issues with instrumentation used to analyse these samples.

Microscope slides must have the patient’s forename, surname and date of birth written in pencil.

Major Incidents – In the event of a major incident the 10 digit Majax number MUST be used in place of an NHS number.

Samples or request forms received without the minimum essential identification criteria stated in this policy may not be processed. Samples received without a request form may also be rejected.

The action taken subsequently may reflect the purpose for which the specimen was intended but might include:-

· Processing the sample and withholding results.

· Sealing the sample and storing it.

· Requesting a fresh sample and request form.

In cases where an inadequately labelled request form/sample is received from a patient who is not easily accessible for a repeat, then, at the discretion of senior laboratory staff, the sample may be processed and the report will show a clear disclaimer detailing the shortcomings of the sample and/or request. The disclaimer will alert the requesting practitioner to take responsibility for the results and for any action taken as a result of the report.

Samples must be refrigerated before delivery if prolonged delay or the specimen should be taken to pathology reception at WRH, podded from ward or in the case of Alexandra hospital it must be delivered to Pathology reception for transportation to Microbiology department. In the case of GP/GUM sample to be delivered as per courier timetable.

2.    Further Acceptance and Rejection Criteria

The quality of laboratory test results depends on the proper collection and handling of the specimen. Correct patient preparation, specimen collection, packaging and transportation are essential factors in obtaining timely and valid test results.

Particular note should be taken of:

· The need for prior notification of request to laboratory.

·  Specimen integrity; e.g. special transport (including urgent transportation) and packaging requirements.

·  Sample size requirements. When only a small amount of sample is obtained, indicate which test(s) are clinically most important.

·  Use of preservatives/transport media.

·  Time critical specimens (e.g. antibiotic assay, U & E, cortisol).

·  Correct tubes/appropriate containers i.e. ONLY those provided/approved by laboratory (refer to Pathology Website).

·  Correct sample(s) for request/test(s).

·   “Order of Draw” chart for BD Vacutainer System to avoid sample contamination.

·   Correct mixing of the sample post collection

·  Delivery to correct laboratory in a timely fashion.

Samples should be sent to the laboratory with minimal delay. Samples received following an excessive period of time may be rejected.

Specimens sent in an unsafe manner that pose handling and health hazards may be rejected.

Specimens received that are not appropriate for the investigation requested will be rejected.

Requests for inappropriate investigations will be rejected (e.g. Hepatitis C virus quantification without prior positive diagnostic serology).

Request forms received without a sample will be rejected.

Requester will be notified verbally or via the reporting process in accordance with local procedures.

Request forms

Please use ICE electronic ordering for all microbiology requests. If ICE is not available use microbiology/virology/antibiotic assay request forms.  For further information on how to use ICE electronic ordering please visit http://nww.worcsacute.nhs.uk/departments-a-to-z/acute-ict/it-training/ice-order-communications/.

Private patients or category 2 requests should be indicated on the request form.

Virology blood test add-ons

Add-ons for routine tests e.g. measles and varicella that are requested within 28 days of the receipt of a gold-top blood in virology may be tested.  Antenatal samples are stored for 2 years so add-ons may be requested for these samples within this time frame. However, due to the variety of tests that can be requested, time dependency of the tests, the different tube types and storage demands, not all tests can be done as an add on. If the requester is unsure as to whether the test can be added on to an existing blood sample, please ring the virology laboratory directly and speak to a biomedical scientist who would be able to advise as to whether the add on can be done.

If a HIV add on is requested, a request form needs to be received in the laboratory before testing.

PHE guidelines for issuing varicella-zoster immunoglobulin (VZIG)

Guidance on use of Varicella Zoster Immunoglobulin (VZIG) during supply shortage

 Protocol for the performance of venepuncture

Clinical information

Please provide relevant clinical information on the request form.

For example:

• Diagnosis, what antibiotics the patient was on prior to taking the specimen or what antibiotics are to be started
• Date of onset and clinical symptoms are particularly important for serological samples so that the appropriate tests can be performed
• History of foreign travel for investigation of enteric pathogens
• Wound swabs - state site of wound as this will determine significance of any organisms isolated

Specimen containers

Worcestershire Royal Hospital
Most containers are available through the distribution stores. 

The following are available direct from the microbiology lab:

• Per and post-nasal swabs
• Chlamydia transport collection kit
• Early morning urine containers for TB
• Viral transport media
• Skin scraping kits
• Medico-legal kits

Alexandra Hospital, Redditch
All requests for specimen containers should be made using a microbiology consumables order form, available from pathology specimen reception. Contact wah-tr.pathology.orders@nhs.net.