Telephone Extensions
Consultant Microbiologist |
Dr
Papu De |
 |
2236 Bleep 238 |
|
Consultant Microbiologist
|
Dr Das Pillay |
 |
2238 Bleep 239 |
Medical Secretary |
Helen Harris
|
 |
2231 |
| Clinical Nurse Specialist Infection
Control |
Avril
Hamilton
|
|
Ext 2284 Bleep
229 |
| Clinical Nurse Specialist Infection
Control |
Elizabeth
Blackham |
 |
Ext 2284 Bleep 228 |
| Head Biomedical Scientist |
Keith Burrows
|
 |
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
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
|

| Per-nasal Swab |
Specimens
- For Bordetella pertussis culture.
Performed/ Reported
|

| Pus including wound drainage |
Specimens
- Sterile universal. N.B. Pus is always
preferable to a Swab.
- Specify if TB culture is required.
Performed/ Reported
Please 'phone the
Laboratory if urgent results are required
|
| Sputum routine
culture |
Specimens
- Plastic sputum container.
Minimum 2ml required.
Performed/ Reported
|
| 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
|
| Urethral swab |
Specimens
- Swab in transport medium.
- Culture includes N. gonorrhoeae.
Performed/ Reported
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
|
| 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
|
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
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
Performed / Reported
|
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
|
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.