South user manual

The Clinical Microbiology service for Greater Glasgow and Clyde is delivered from 2 laboratories based at Glasgow Royal Infirmary and Queen Elizabeth University Hospital.

Each laboratory provides a full and comprehensive microbiology service to the population of Glasgow and Clyde and is fully accessible to hospital based users. This includes medical, nursing, pharmacy and other staff employed by Greater Glasgow and Clyde Health Board, users in primary care and general practice and customers in the private sector. The laboratories process approximately 750,000 specimens per annum.

The clinical microbiology laboratory based at Queen Elizabeth University Hospital provides a, modern diagnostic service which includes testing of clinically important bacteria, fungi and parasites using microscopy, culture and antimicrobial susceptibility testing where appropriate. The laboratory is United Kingdom Accreditation Service (UKAS) accredited and is performance assessed regularly by a system of internal audit, external audit by UKAS and through participation in inter-laboratory comparison schemes such as the National External Quality Assurance Scheme (NEQAS). The laboratory holds ISO 15189 UKAS accreditation for the testing listed on the UKAS website. Please follow link below for full schedule.

https://www.ukas.com/wp-content/uploads/schedule_uploads/00007/8078%20Medical%20Multiple.pdf

Clinical Diagnostic Microbiology service is delivered for the Queen Elizabeth University Hospital, the Royal Hospital for Children, the Victoria Infirmary and General Practices in Glasgow South catchment area as well as Clydebank HC and all GP practices in Clyde catchment area.

The department is located on the 4^th Floor of the Laboratory Medicine and Facilities Management Building.

Microbiology Department

Queen Elizabeth University Hospital

1345 Govan Road

Glasgow

G51 4TF

Tel: 0141 354 9132

Clinical Microbiology Laboratory Office (All general enquiries through this number):

0141 354 9132

(Shortcode from within QEUH 89132)

Key Personnel – Clinical Microbiology Staff

Key Personnel - Microbiology Biomedical Scientist Staff

Infection Control

Local Infection Control Team contact details are provided on the NHSGGC Website.

The National Infection Prevention and Control Manual gives details of the procedures and practices that must be followed to prevent the spread of infection within the hospital (including sharps injuries).

Hours of Service

Weekdays              08.30hrs – 20:30hrs   

Weekends              08.00hrs - 20.00hrs    

Public Holidays      08.00hrs - 20.00hrs

Laboratory Core Hours are 08.30nhrs – 17.00hrs. There is a reduced number of staff in the laboratory between 1700hrs and 20:30hrs in the evening, during the weekend and on public holidays. Hence, a limited service is available on those days and times.

Routine enquiries are made by telephoning the department between 08:30hrs and 17:00hrs Monday - Friday. If within the hospital, dial 89132 or call 0141 354 9132 if calling from outside.

Please restrict telephone requests for results to urgent or doubtful cases.

Ward staff /GPs can access results via Portal. Contact IT Dep to set up access to the system.

Advice on choice of antibiotics, clinical significance of results, investigation of patients with undefined sepsis or pyrexia, or any other microbiological problem including infection control may be obtained from the Microbiology website GGC - Microbiology | Right Decisions (scot.nhs.uk),or by contacting one of the clinical microbiologists by telephoning the number above and following the automated message. This includes information for GP colleagues regarding the GP email advisory service which department operates.

For the out of hours Microbiology service between 17.00hrs and 08:30hrs Mon to Fri and throughout the weekend please contact Switchboard.

Out of Hours Service

The Microbiology on-call service is a non-resident service with regards to clinical advice and urgent/emergency specimen processing; service users should contact switchboard (dial 0141 201 1100 from outside the hospital or 1000 internally) for either of the above services.

Users must ask to speak to either a Biomedical Scientist (BMS) regarding emergency/urgent specimen processing or a Medical Microbiologist (clinician) for clinical advice in terms of treatment/patient management and/or infection control. Junior medical staff must consult the GGC Infection Management Guidelines for Empirical Antibiotic Therapy in Secondary Care before contacting the Microbiologist. In addition, they should discuss cases with senior members of their own clinical team before contacting the Microbiologist.

Service users should only contact the Biomedical Scientist (BMS) if sending the following specimens to the laboratory to be processed as an emergency:

1. Cerebrospinal Fluid (CSF)
2. Any aspirate/specimen from a normally sterile site (e.g. ascitic fluid, peritoneal fluid, joint fluid etc.) Consequently this does not include specimens of sputum or endotracheal secretions, or respiratory films for TB or specimens of faeces
3. Specimens taken in the course of an operative procedure, including specimens obtained by CT guided drainage
4. Urine microscopy in children <=2years (where the outcome may directly influence the decision to undertake surgery). For children >2years contact consultant microbiologist in first instance

Please note that Biomedical Scientists are only authorised to carry out work on the above list of specimens and will ask you to telephone the switchboard again to ask to speak to the Medical Microbiologist for anything else.

Please note that it is the clinician’s responsibility to arrange prompt transport of emergency specimens to the laboratory.

If you are on-site use the PTS but you still require to arrange for BMS to attend the lab (via Switchboard) as staff are non-residential.

*DO NOT use the PTS to send high risk samples or samples that have a risk of TB*

If you are off-site you must arrange transport to deliver the sample(s) to the laboratory.

It is not necessary to contact the on-call BMS when blood cultures have been collected

The portering service delivers samples from within the hospital. Please make use of the PTS for all samples (destination 1618) with the exception of those that are high risk or are requesting TB. The portering service can be used for delivery of these samples.

Out with QEUH, there are several uplifts and deliveries throughout the day for all laboratories and GP practices that we provide service to. Please ensure Microbiology samples are bagged separately from other disciplines and labelled for Microbiology, QEUH.

Tube System (Destination code: 1618)

Do NOT overload containers. This causes difficulty in removing them on receipt and can slow the tube network if overly heavy.

See Tests offered in sampling.

Samples for the following investigations are sent to other hospitals via microbiology

• Amoebic, Borrellia*, Brucella & Hydatid serology
• Legionella Ab and Ag detection
• Leptospirosis, Mycology – culture and serology
• Toxocara, Toxoplasma and Virology – Hepatitis, HIV, PCR, serology and culture
• Agreed therapeutic antibiotic levels

Please use an individual request form and sample for each of these tests, DO NOT request multiple tests from one sample as these are often referred to more than one laboratory.

*Please not that CSF specimens sent for Borrellia testing should have a paired serum taken on the same day.

Most container types are available from National Procurement Logistics, Canderside Toll, Larkhall.  Items are ordered using the PECOS on line ordering system.

Blood culture bottles are supplied by Microbiology (call 89132).

The Greiner “Vacuette” system is in use in GGC.  All specimen containers should be robust and leak proof.  The container must be properly closed and not externally contaminated by the contents, as this is hazardous to all staff coming into contact with these samples.

The table below shoes the appropriate specimen container for each specimen/investigation.

Taking specimens in clinical areas

These are generic instructions for all samples:

• Confirm the identity of the patient
• Explain the procedure to the patient and obtain consent (as appropriate)
• Consent to treatment is the principle that a person must give permission before they receive any type of medical treatment, tests or examination. The principle of consent is an important part of medical ethics and the international human rights law. For full details refer to the NHS Consent to Treatment webpage.
• Check that the specimen container is appropriate for the test
• Perform hand hygiene
• Take all required equipment to the patient
• After taking sample ensure closure / security of the sample
• Complete documentation near the patient
• Ensure the outside of the container is not contaminated

     (If so, either repeat the sample or clean container with alcohol wipe)

• Place in specimen bag for delivery to the lab

Patient Collected Samples

Where patients are required to take their own samples they can be referred to the NHS website that provides advice on how samples should be taken.

How should I collect and store a urine sample?

How should I collect and store a faeces sample?

Identification and Labelling of Specimens

Specimens must be correctly assigned to patients and labelled correctly to prevent results from being attributed to the wrong patient. Failure at this stage can lead to serious adverse patient impact (see request form requirements below).

One form for each specimen please

Where possible, please use electronic ordering systems for all microbiology requests. If electronic systems are unavailable then microbiology request forms are the preferred option. Click here for PDF Request Form for QEUH Microbiology. In exceptional circumstances, should microbiology request forms not be available then a form containing all of the essential information including investigation required will be considered as a request form. Essential and desirable information for the request form and sample is given in the following table.

Specimen/Request Form Essential and Desirable Information                                          

It is the responsibility of the requester to ensure that the sample and request form are correctly labelled with, as a minimum, the patient name, DOB or CHI / Hospital number and specimen type. The specimen type and site must also be identified on the specimen container and the request form.

Unlabelled or incorrectly labelled specimens or forms may not be processed and will be discarded in all but exceptional circumstances.

Easily repeatable leaking samples may be rejected.

Failure to provide essential patient details, in particular ward location or GP practice will result in a delay in receipt of telephoned/written reports.

If the sample poses a potential laboratory hazard because the patient is Hep B/C positive, HIV positive or an intravenous drug user, please indicate this on the request form.

Deviating samples can be defined as those which may have exceeded their maximum holding time, have not been retained at appropriate temperatures or presented in inappropriate containers. Where the integrity may have been compromised prior to receipt this should be defined as deviating if processed.

Deviating samples may jeopardise the validity of the report. Additionally, there may be instances where a laboratory by its own actions (or inactions) allows a sample or item to become deviating after it has been received. Deviating samples will be reported with the appropriate comments.

General guidelines for examples of deviation are shown in the table below

In general

• Fresh samples are best
• If processing is delayed, refrigeration is preferable to storage at ambient temperature (other than blood cultures & CSF)
• Delays of over 48hr are undesirable
• Specimens received in formalin are not suitable for Bacteriology culture

Precious samples (unrepeatable) will always be processed but if they are considered deviating will be reported as such with a disclaimer that the result may be invalid.

Requests for Further Investigations

Requests for further investigations on samples can be considered up to 24hrs after receipt. However, the quality of samples diminishes with time and fresh samples are always encouraged unless they are unrepeatable e.g. theatre tissue.

Printed Results

All results are authorised for printing / release by appropriate grade of staff. Reports are printed where applicable and dispatched every working day, Monday to Friday.

Interim and final results are available on TRAKcare system & Clinical portal and this is updated in real time.

Apart from negative urines and negative MRSA samples, which can be reported after one working day, most Microbiology culture results are reported after 2-5 days, depending on the investigation.  See turnaround times

Copies of printed reports can be obtained upon request.  Clinical Reports are never faxed.

Blood Cultures

• All significant positive results shall be telephoned to the requesting clinician as soon as they are available. If there is no growth after 48 hours (of processing, not 48 hours after collection), a report to that effect is issued, but specimen processing continues for a total of five days.

 Telephoned Results

• Results of urgent requests – and those identified by the clinical microbiologist - will be telephoned to the requesting doctor or, in some cases, to the senior ward or clinic nurse. This includes all significant positive blood cultures and positive CSF results.
• Results of epidemiological importance are always telephoned.

Using the Microbiology Result

This is often the most subjective part of microbiology. Many factors, including host immunity, site of infection, previous/current antibiotic therapy etc may be involved in determining whether a result is clinically significant or not. The clinical microbiologists are available to discuss the clinical relevance of results.

This table gives the length of time taken to generate a report on typical specimens of various kinds. The actual turnaround times (taken from when we receive the specimen to when the report is issued) are audited on a regular basis and are available on request. The majority (>95%) of specimens can expect to be processed within these time periods, but as mentioned before, several factors may lead to delay in processing a specimen and thus it is inevitable some specimens will be out with these targets. If additional examinations are required it is essential to notify the department as soon as possible to determine if they can be carried out.

Typical Turn-around times for common specimens

95% of specimens should be authorised /reported within the target time. This is the time between receipt of sample and first authorisation/report.

The Microbiology department at QEUH participates in several EQA schemes, including those run by the UK National External Quality Assurance Scheme (NEQAS).

Details of participation in specific schemes are available on request.

The laboratory adheres to Data Protection Law and holds all patient information in a secure manner. Staff undertake appropriate Learnpro modules that cover all statutory and mandatory requirements relating to data protection. For full details refer to the NHS GG&C Data Protection link below.

http://www.staffnet.ggc.scot.nhs.uk/Corporate%20Services/eHealth/InfoGovIndex/Pages/DataProtection.aspx

Please note: StaffNet pages can only be accessed from an NHS device on the NHS network

Any complaints regarding the service of the Laboratory should be communicated directly to any member of the Laboratory Management Team. All complaints will be recorded formally within the QPulse electronic system upon where a full investigation will be carried out. All complaints will receive a response from management.

NHS GG&C Complaints procedure can be access directly from staff net or from the link below.

http://www.staffnet.ggc.scot.nhs.uk/Corporate%20Services/Complaints/Pages/NHSComplaints.aspx

Please note: StaffNet pages can only be accessed from an NHS device on the NHS network

Users are encouraged to give feedback to the department. This can be done by contacting the laboratory by telephoning using the stated contacts listed in this manual or email.

User feedback can also be submitted electronically on the GG&C Microbiology website Microbiology feedback form