The Microbiology Laboratory provides an extensive clinical service, including Bacteriology, Virology, Serology, Parasitology and Mycology to hospitals, General Practitioners and Environmental Health Officers.  It also provides an Infection Control Service and advice. There a staff trained in the specialist area of deliberate release of biological agents.

It provides epidemiological data for the Communicable Disease Surveillance Centre in the Health Protection Agency, Colindale, and investigates outbreaks/incidents of infectious disease in support of the Consultant in health Protection.

The Microbiology Laboratory belongs to National External Quality Assurance Schemes (NEQAS) in all main diagnostic areas to ensure quality of service. 

The laboratory has conditional approval with the Clinical Pathology Accreditation (CPA) scheme.

For test repertoire and specific microbiology test information including turn-around-times and urgent request procedures - see Table 1 below.

2 Laboratory opening times and on-call service

Normal hours of service

Most routine specimens are accepted during the following hours:

Monday to Friday                  9am                 to                     5.15pm
Saturday                                9am                 to                     12noon

During normal laboratory hours please telephone urgent requests direct to the laboratory on Ext 4338 to ensure priority processing.  Either bring the specimen to the laboratory reception yourself, or arrange urgent transport.

Outside normal hours of service (on-call)

N.B. The Microbiology on-call staff do not work the same shift patterns as Clinical Pathology and MUST  be contacted for urgent tests required outside of routine hours.

There is a 24-hour on-call service.  The on-call Biomedical Scientist (BMS) can be contacted through the hospital switchboard.  Specimens will be processed outside normal laboratory hours if requested and agreed criteria are satisfied.

Appropriate specimens for urgent examination on-call include:

• cerebrospinal fluid (CSF)
  
• operative specimens such as biopsies or pus including drainage of empyema
• urine microscopy in children where it may influence the decision for acute abdominal surgery
• cultures in pyrexial patients with neutropenia or in labour

Bank Holiday cover

Urgent specimens requiring processing on Bank Holidays will be dealt with by the on-call BMS.  However, qualified staff will be present in the laboratory to process routine specimens at certain times. If you require urgent work processed or information - try Ext 4338 or page the on-call technical staff via switchboard.

Always check policies and refer to senior staff before contacting the Consultant Microbiologist for advice.

For advice on diagnosis and the interpretation of microbiology results or antimicrobial use, contact the duty Consultant Microbiologist.

During normal working hours (as above) contact Duty Consultant on Ext 4343

Outside of normal hours contact duty Consultant through the hospital switchboard.

There are cross-cover arrangements with Salisbury District Hospital over weekends.

4 Infection Control Advice.

For advice on infection control issues including the use of containment facilities refer to local policies on the hospital intranet.  For queries not covered by the policies contact Infection Prevention and Control on Ext 4343.

5 Results and reports

Results

All authorised results are available on the computer.

Always check the Sunquest laboratory information system (LIMS) for results before telephoning the laboratory. If results are not available on the computer an update may be available from the laboratory on Ext 4343.

Reports are available electronically every working day.  Most bacteriology culture results are reported after 2-5 days, depending on the investigation. Urine microscopy results are available on the day of receipt Monday to Saturday lunchtime. Serology and virology results and reporting depends on the frequency of testing and the urgency of the request.

Telephone results

Results of urgent requests will be available on the computer as soon as possible.  Urgent results that cannot be input onto the computer for whatever reason will be telephoned if they will aid immediate patient management. This includes all positive blood cultures and CSF results.

The Microbiology Laboratory is located on level 3 of North wing at Dorset County Hospital.  A detailed map can be found on the Trust Intranet site.

7 Visitors

The laboratories are protected by security doors.

Visitors should introduce themselves at the Pathology Patient reception area.  The person they wish to see will come out to meet them.  Always make appointments in advance to ensure the right person is available. All visitors are requested to read the ‘instructions for visitors’ as they enter Pathology.

8 Staff and telephone numbers

General laboratory telephone: 01305 251150 or 01305 25xxxx followed by the extension you require.
Microbiology FAX number is 01305 251044

9 Sample requirements

Sample requirements for each test are outlined in the ‘search tests’ section link below.

Receipt of specimens

During normal working hours, all specimens are received at the laboratory specimen reception area. Approved samples can be sent via the vacuum transport tube. See POD Vacuum Transport system policy and guidance on the intranet. If delivering in person, follow the signposts at the top of the stairs/lift in North Wing.  Outside normal working hours, non-urgent specimens may be left at the out of hour reception area at the back door of the laboratory.

For urgent specimens out-of-hours contact the on-call Biomedical Scientist through the hospital switchboard.

See below for the other ways samples may be sent.

Supply of specimen containers

Most sample containers are obtained via the stores supply system.

The following are obtained direct from the laboratory by phoning 4338.

• Blood culture bottles - store at room temperature in the dark.  Keep bottles of each set together and return any unused bottles. Tell laboratory staff if you require ordinary sets or those sets for patients on antibiotics.  Ensure the stock is used in turn and always within its expiry date.
• Chlamydia collection kit – store at room temperature. Check expiry date
• Per nasal swab/plate kits for whooping cough - store at 4oC. Check expiry date
• Virus transport media for NPAs (nasopharyngeal aspirate) – store at room temperature. Check expiry date

All other supplies are obtained via the normal hospital supplies system.

10 Request forms

A hand-written, printed or ICE request form must accompany all specimens sent to the laboratory.  It should clearly state the following information:

• patient name and if possible an address
• unit number/NHS number
• date of birth
• sex
• ward/GP name or code/address for report/bleep number
• type of specimen
• date and time specimen taken
• tests required
• all relevant clinical details including any antibiotic treatment (recent, current and intended) and foreign travel
• risk status if applicable* SEE High Risk Specimen section below.
• date of onset and duration of illness, particularly for serology
• in the case of antibiotic assays, date and time of last dose of antibiotic and time blood was collected.
• specify anatomical site from which "wound" specimens were taken

COMPREHENSIVE CLINICAL INFORMATION IS ESSENTIAL

It will not only improve and enhance the relevance of any result but will ensure appropriate tests are carried out. The minimum information should include underlying serious medical history, if the patient is unwell, why this particular sample is being submitted and any presumptive or suspected diagnosis. This will also allow laboratory staff to assess any high-risk samples.

Useful clinical information

• useful epidemiological information, eg: diarrhoea  - other guests at party reported ill
• children and ? Shigella sonnei - give the name of the school
• adults and ? Salmonella - give the place of work, work in industry, farmer
• all patients and ? Campylobacter, Giardia, Cryptosporidium - cattle farmer, exposure to water through recreation or work.
• If the patient has been abroad – give location and duration of stay/return date.

Please note: It is not laboratory policy to process unlabelled/ inadequately or wrongly labelled samples.

All samples are treated as high risk (under universal precautions) however, best practice dictates that samples from patient groups or disease processes listed below, should have their ‘high risk’ status noted on the request form.
This is best done by giving full medical history.

See information from Health and Safety Executive (HSE) and Advisory Committee on Dangerous Pathogens (ACDP).
HSE       http://www.hse.gov.uk/biosafety/infection.htm
ACDP   http://www.dh.gov.uk/ab/ACDP/index.htm
High risk samples are defined as coming from the following groups:

• Those known to be Hepatitis B surface antigen, Hepatitis C positive or HIV antibody positive.
• Those whose HIV or Hepatitis B status is unknown but who have evidence of AIDS or HIV disease or who are jaundiced.
• Those with known or suspected CJD.
• Those with known or suspected typhoid fever.
• Faeces from patients with known or suspected typhoid, E coli 0157, dysentery.
• Sputum or bronchial washing/lavage from suspected or known TB.
• Pyrexia of unknown origin (PUO) –  if patient has been abroad
• Any suspicion of a blood-borne virus
• Suspected diphtheria
• Suspected meningococcal meningitis

12 Specimen transport

Specimens should be placed in the appropriate container and must be securely fastened. 

This must be placed in a clear plastic bag and sealed.

PLACE REQUEST FORM IN THE POCKET - NOT IN THE BAG WITH THE SAMPLE

• If the specimen is to be posted the packaging MUST comply with UN3733 packaging regulations and postal regulations.
• If the vacuum transport system is used see the Intranet for detailed instructions.
• Porters should be called for samples that cannot be transported through the vacuum system, if the system is not working or the location does not have a carrier station.
• If the vehicle transport system (brake) is being used any sample must be appropriately packaged in UN3733 compliant packaging for safe transportation.

• CSFs
• Large volume liquids e.g. 250ml urine containers for TB

Specimens may not be suitable for testing if they are so inadequately labelled that the patient's identification is in doubt, or if they have leaked or been contaminated.  In these circumstances every effort is made to inform the requesting doctor first.

13 Safety when collecting samples

Great care must be taken in obtaining any specimens.  Equipment such as needles and blades must be immediately disposed of safely in approved "sharps" boxes.

Should a spillage of blood, fluids or tissues, or of other specimens, occur, this should be made safe and disposed of, no matter what the risk status of the patient.

Specimens should be transported to the laboratory as rapidly as possible after collection to allow for the most accurate interpretation of results.

14 Sample collection information

For test repertoire and specific microbiology test information including turn-around-times and urgent request procedures - see Table 1 below.

For methods and information on how to collect those samples refer to the document:

http://194.101.238.20/ClinGuide/Infection-Control/0323-2-specimen.pdf

General information:

The best results are obtained when an appropriate, well taken specimen, in the proper container, is delivered to the laboratory promptly and relevant clinical information is provided on the request form.

(For details of sample collection containers and requirements go to the sample enquiry section)

General guidelines on microbiology specimen collection are:

• do not send specimens in non-sterile containers
• where possible specimens should be obtained before antimicrobial agents have been administered
• an adequate quantity of material should be obtained for complete examination.  Always send pus ( in a universal container) rather than a swab of the pus
  
• the specimen taken should be representative of the disease process.  For example, material swabbed from the opening of a sinus tract is more likely to yield commensal organisms on the skin than would material obtained by curettage or biopsy of the base of the tract
• care must be taken to avoid contamination of the specimen by micro-organisms normally found on the skin and mucus membranes.  Sterile equipment and aseptic technique must be used for collecting specimens, particularly for those from normally sterile sites
• material must be transported promptly to the laboratory.  Fastidious organisms may not survive prolonged storage or may be overgrown by less fastidious organisms before culture can be undertaken.

Please contact the laboratory if there is any doubt about the best specimen to take or concerning the availability of a test

15 Collection of Blood Cultures.

The document ‘POLICY FOR TAKING BLOOD CULTURES’ can be found on the Infection Prevention and Control intranet site.

http://194.101.238.20/ClinGuide/Infection-Control/0798-2-Blood-Cultures.pdf

It contains full information on the rationale for blood culture sampling, indications for sampling, when to take samples, procedure for taking blood cultures and the equipment required.

16 Microbiology Test Repertoire Table 1

Please click here to open the Microbiology Test Repertoire.  This page will open in a new window.

 Version 4 updated 1st September 2009