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Part of the Bacteriology section

 

 

 

Telephone Extensions

Consultant Microbiologist                                        

Dr Papu De 

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2236 Bleep 238

Consultant Microbiologist

Dr Das Pillay 

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2238 Bleep 239

Medical Secretary  

Helen Harris 

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2231
Clinical Nurse Specialist Infection Control Avril Hamilton  Click to view photo Ext 2284 Bleep 229
Clinical Nurse Specialist Infection Control Elizabeth Blackham  Click to view photo Ext 2284 Bleep 228
Head Biomedical Scientist Keith Burrows  Click to view photo 2242
Customer Service Representative Kathy Orange    
Laboratory     2232/2233
Serology     2235
Customer Service Direct Line     0121-311 1142
Fax No     0121-378 6154

 

Out of hours Emergency Service

Tests are available by arrangement with Microbiology staff, via the hospital switchboard, after 6.30 pm Monday-Friday, and 5.00 pm at weekends.

Specimens are considered to be urgent where an early diagnosis would be beneficial to the management of the patients’ treatment.

  • Cerebrospinal Fluid (CSF) from patients with suspected meningitis or fluids from patients with septic arthritis are examples
  • Surgical wound swabs taken during urgent evening surgery may also be sent for culture
  • Other specimens may be requested particularly by paediatricians.
    eg: urgent urine cell-counts 

Medical advice can be obtained from the Consultant via the Hospital switchboard.

Relevant clinical details are important to ensure that appropriate investigations are performed on each specimen. Current or intended antimicrobial therapy should be stated on the request form.

Bacteriology  

The Bacteriology section of the Microbiology Department deals with the isolation, identification, and antibiotic sensitivity testing of clinically significant bacterial isolates.
 Many bacteriological investigations initially involve the inoculation of the specimen onto various culture media such as agar nutrient plates, followed by overnight incubation at body temperature (37c) to produce discrete growths (colonies) of each bacterial type which may be present.
Initial bacterial culture results are therefore rarely available until the day after receipt of the specimen and the final result may take a further one or more days.

Examination for certain organisms may take longer than that listed below

Blood culture        N.B. See details of blood culture phlebotomy procedure
Specimens
  • 10 ml of blood into each blood culture bottle (aerobic and anaerobic).
  • 1-3ml of blood for Neonates into single "Peds-Plus" bottle.

    Please send immediately to the laboratory, or incubator if out of hours.

Performed/ Reported

  • Daily
  • Negative results reported after 2 days, although incubation is continued for 5 days.
  • Positive results are reported as they occur.
  • Significant results are telephoned.
    •

All blood cultures are treated as urgent specimens and it is not necessary to phone Microbiology out of hours.

CSF
Specimens
  • 1-2ml of CSF into 3 sterile universal containers labelled '1'  '2' and '3' from three consecutive samples.
  • 2-3ml of CSF for TB cultures. Must be clearly specified on the request form.
  • If viral PCR (HSV or VZ) is required, this should also be clearly specified on the request form as it is not routinely done.

Performed/Reported

  • Daily.
  • Cell count and Gram stain reported  immediately.
  • Culture result takes up to 2 days.
  • All significant and urgent out of hours results are telephoned.
The Laboratory or Biomedical Scientist on call (if out of hours) should always be notified when sending CSF samples

Faeces
Specimens
  • 2 - 3 spoons in plastic faeces container.
  • Routine examination for Salmonella, Shigella, Campylobacter, E.coli 0157 and Cryptosporidium.
  • Additional tests are performed where clinical details are suggestive or if specifically requested. eg ova, cysts and parasites, Rotavirus, Adenovirus, Clostridium difficile toxin. (N.B. Minimum 2ml sample required)
  • 'Hot' Stool sample must be sent to the Laboratory within 20mns of voiding.

N.B. Please telephone the Laboratory when sending urgent samples such as 'hot' stools.

Performed/ Reported

  • Daily.  ( Negative reports take 2 days ).
  • Significant results are telephoned.

    Send a sellotape slide for examination for threadworm ova (Enterobius vermicularis)

Fluids eg Peritoneal, ascitic and joint
Specimens
  • 20 ml in sterile universal.

Performed/ Reported

  • Daily / 1 - 3 days

Please  'phone the Laboratory if urgent results are required

High Vaginal Swab
Specimens
  • Swab in transport medium.
  • Routinely examined for Trichomonas vaginalis, Bacterial vaginosis and Candida.
  • Culture for other organisms where clinically indicated.
  • Additional culture for N. gonorrhoeae in women between 16 and 60 (Blood cultures and  direct laparoscopic culture should also be considered).
  • Direct smears, urethral and cervical swabs in addition to HVS should be submitted for  N. gonorrhoeae.
  • Chlamydia : See appropriate section.

Performed/ Reported

  • Daily / 1 -2 days
    •

Per-nasal Swab
Specimens
  • For Bordetella pertussis culture.

Performed/ Reported

  • Daily / 5 days
    •

Pus including wound drainage
Specimens
  • Sterile universal.    N.B. Pus is always preferable to a Swab.
  • Specify if TB culture is required.

Performed/ Reported

  • Daily / 1 - 3 days.

Please  'phone the Laboratory if urgent results are required

Sputum routine culture
Specimens
  • Plastic sputum container.
    Minimum 2ml required.
    •

Performed/ Reported

  • Daily / 1 - 3 days
    •

Sputum for T.B
Specimens
  • Sterile universal.
  • If sputum unavailable send bronchial washings, laryngeal swab or gastric washings.
  • Minimum 2ml sample required.

Performed/ Reported

  • Microsopy: (AFB staining) : Daily.
  • Culture : Weekly.  
    Incubation is continued for 8 weeks. 
  • Positive result usually reported after 2- 3 weeks.
    Positive results are sent to Heartlands Hospital for antibiotic sensitivity testing.

       New positive smears or cultures are phoned immediately.

 

Swabs - Miscellaneous
Specimens
  • Swab in transport medium 
    eg Throat swab, Ear swab, Neonatal screen swabs, Wound swab.

Performed/ Reported

  • Daily / 1 - 3 days

Urethral swab
Specimens
  • Swab in transport medium.
  • Culture includes N. gonorrhoeae.

Performed/ Reported

  • Daily / 1 - 3 days.

Chlamydia - see appropriate section

Urine : Routine MSU or CSU
Specimens
  • 20 ml in red-capped sterile universal containing boric acid (fill to mark).
  • Smaller volumes of urine (eg from babies) should be submitted in  white-capped sterile universal.

Performed/ Reported

  • Daily / 1 - 2 days

Urine for TB
Specimens
  • 3 complete, early morning urines in sterile 500 ml bottles. 
  • Bottles are available on request from Microbiology.

Performed/ Reported

  • Culture : Weekly. Incubation continued for 8 weeks. 
  • Positive results are usually reported after 2 -3 weeks.
  • New positive cultures are telephoned immediately.

Urine for Legionella antigen
Specimens
  • 10-20 ml in white capped sterile universal.

Performed/ Reported

  • Tests performed at Heartlands Hospital.
  • Reported in 3-7 days.

Chlamydia

Please contact the Laboratory to discuss any problems relating to the diagnosis of Chlamydia infections.
VTM for Chlamydial culture and collection kits for DAKO EIA supplied by the Laboratory (Ext.2233).
Endocervical & Urethral swabs EIA

Specimens
  • Endocervical swab (female),  Urethral swab (female/male).

Performed/ Reported

  • DAKO EIA 1 - 2 days.
Urine - PCR

Specimens
  • Male and Female : First pass urine into white top universal
  • Used to confirm previous positive/equivocal EIA results

Performed/ Reported

  • Sent to Heartlands Hospital
  • Result in 3 - 5 days
Conjunctival scrapings (neonate) - Culture

Specimens
  • Swab in viral transport Medium (available from the Laboratory)

Performed/ Reported

  • Result in 6-10 days
    Cultured at Birmingham City Hospital
Conjunctival scrapings (neonate) - Immunofluorescence

Specimens
  • Conjunctival scraping - Smear directly on to special slide and fix with acetone prior to sending to Lab.

Performed/ Reported

  • Sent to Heartlands Hospital.
  • Examined by direct immunofluorescence

Mycology

Skin scrapings, hair, Nail Clippings
Specimens
  • Please submit an amount in clean, coloured, paper envelope (preferably black), between glass slides or in universals.

Performed/ Reported

  • Microscopy performed daily.
  • Culture takes up to 3 weeks.

Virology

Rotavirus / Adenovirus

Specimens
  • 2 - 3 spoons faeces in plastic faeces container.

Performed/ Reported

  • Test performed daily.  Positive results are phoned immediately.

RSV

Specimens
  • Nasopharyngeal aspirate.

Performed/ Reported

  • Daily / Same day.  Positive results are phoned immediately.

The following virology tests are referred daily to the Regional Virus Laboratory
Transport leaves Good Hope Hospital at approx. 1.00 pm.
Electron microscopy of Skin Lesions

Specimens
  • Smear on glass slide.

Performed / Reported

  • Result take 1 - 2 days.

Viral Culture

Specimens
  • Faeces : 2 - 3 spoons n sterile container.
  • CSF in sterile container. 
  • Throat swab or washings in viral transport medium (available from laboratory).
  • Urine : 10 ml fresh urine in white capped sterile universal.
  • Swabs from genital sites : In viral transport medium (available from Laboratory)

Performed / Reported

  • Result takes up to 3 weeks

 

 

Investigation of 
Congenital infection or Intrauterine death

For diagnosis of possible congenital viral infection in a neonate send :
  • Urine for CMV culture - If <3months send urine for CMV PCR. If >3 months send EDTA blood for CMV PCR
  • Throat swab in viral transport medium.
  • Blood (clotted) for Rubella IgM and Toxoplasma.

For diagnosis of infection as a cause of intrauterine death send :

  • Maternal blood for CMV IgM, Rubella IgM and Toxoplasma serology.

 

Serology

In addition to relevant clinical details, it is important to state the date of onset of symptoms.
 If no clinical details are clearly stated on the request form, the sample will be stored.

The following tests are performed at Good Hope Hospital. The majority are performed in batches (2 or 3 times a week) but urgent tests may be performed by arrangement with the Laboratory (extn 2235).
A minimum of 5-10 ml of clotted blood is required for each test 
Antistreptolysin 0 (ASO) titre
Hepatitis A IgM
Hepatitis B surface antigen
Hepatitis B surface antibody
Hepatitis B core antibody
Hepatitis C antibody
HIV serology (combined HIV/HIV2 antibody and HIV1 p24 antigen) *
Toxoplasma total antibody
Syphillis serology (Treponema pallidum IgG and IgM)
Mycoplasma antibody IgM
Helicobacter pylori (H.pylori)
Varicella zoster - previous immunisation IgG
Rubella IgG antibodies


*Informed consent is required before taking blood for HIV.
   Please state on the request form that this has been obtained.
   The form must be signed by the requesting doctor

 

The following tests are sent to Reference Laboratories. Results may take 7 - 10 days.
A minimum of 5-10 ml of clotted blood is required    
Antistaphylolysin titre
Aspergillus precipitins
Brucella CFTS  
Atypical pneumonia screen *  Coxiella burnetii (Q fever) Mycoplasma Influenzae
Adenovirus Chlamydial agents
Psittacosis ornithosis Avian precipitins
Enteroviruses PCR 
Epstein-Barr virus (EBV) IgM
Hepatitis A IgG (Immunity for travellers)
Legionella antibody 
Legionella antigen       Note: MSU required, not blood
Leptospira IgM 
Lyme disease (Borrelia burgdorferi antibody)
Meningococcal PCR (EDTA blood)
Parvovirus IgG and IgM
Rickettsia antibody
Rubella IgM antibodies
Toxocara antibodies

* The Reference Laboratory will NOT routinely accept these requests unless acute and convalescent sera (10-14 days apart) are sent.

For further information regarding investigations not listed, please contact the Consultant Microbiologist

 
Blood borne viral loads   i.e. HIV, Hepatitis C, Hepatitis B

Specimen
  • 2 x EDTA bloods required per viral load.
  • Please specify whether quantitative or qualitative PCR is required for Hepatitis C.
  • If genotyping is required for Hepatitis C, an extra EDTA blood is required.

Performed/Reported

  • 7 - 10 days

 

Vancomycin & Gentamicin Assays

Antibiotic Assays : Gentamicin and Vancomycin
Performed Monday to Saturday at Good Hope Hospital, but prior notification required by the laboratory. Samples should reach the laboratory by 4.30 pm on Monday to Friday and 12 noon on Saturday.
Samples should be taken by a doctor looking after the patient and not a Phlebotomist.
The samples required are as follows:-

 
VANCOMYCIN    See full guidelines
Sample Required Timing Reference Range
Pre dose only 5 ml clotted blood taken 
5-30 mins before dose		 5 - 20 mg/L

Please state dose, time of dose and time blood was taken on request form.

 

GENTAMICIN  once daily dosing.   Discuss dose with Consultant Microbiologist
Sample Required Timing Reference Range
6 - 13 hour post dose only 5 ml clotted blood taken 
6 - 13 hours after dose.  Please state exact time		 See nomogram and/or discuss with Microbiologist.

Please state dose, time of dose and time blood was taken on request form.

 

GENTAMICIN standard dosing.   See B.N.F. for dose
Sample Required Timing Reference Range
Pre and post dose levels. Pre dose 5 mins before dose.  Post dose 1 hour after dose. Pre dose < 2mg/L
  Post dose 3-5 mg/L for Streptococcal Endocarditis
 

 

 Post dose 5-10 mg/L for other infection

Please state dose, time of dose and time blood was taken on request form.