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Pathology Handbook

Pathology User Handbook

Section 5: Microbiology – Bath/Bristol HPA Laboratory

Table of Contents

5.1 Background

The HPA Department/Laboratory of Microbiology is committed to the provision of a high quality service for the diagnosis, prevention and control of infection and communicable diseases in patients in hospitals and the community. A limited range of specimens are processed in the on-site laboratory, whilst all other specimens are transported to the Health Protection Agency Laboratory in Bristol for examination: Medical and technical staff are always available on-site (or via switchboard out of hours) at the RUH.

A comprehensive range of tests is provided covering clinical bacteriology, virology, serology, parasitology and mycology. In addition a wide variety of food, water and environmental investigations are undertaken providing microbiological support to seven Local Authority Environmental Health Departments. As part of the Health Protection Agency Laboratory Service (HPA) network, the laboratory has direct access to the specialist services of reference laboratories and the Communicable Disease Surveillance Centre (CDSC) and participates in local and national epidemiology.

The laboratory takes part in the U.K. National External Quality Assessment Scheme (NEQAS) for Microbiology and the HPA External Quality Assessment Schemes for food and water microbiology performing to a consistently high standard. The laboratory is accredited with the Clinical Pathology Accreditation (UK).

The Clinical Team consists of:
Dr Sarah Meisner – Consultant Microbiologist
Dr Susan Murray – Consultant Clinical Scientist
Dr Beverley Palmer – Consultant Microbiologist
Dr Ebi Abrishami – Consultant Microbiologist

On-site Laboratory Working Hours
Monday - Friday: 09.00 - 17.00
Saturdays and Bank Holidays: 09.00 - 12.00

Outside these hours an 'on-call' service operates for urgent specimens. On-call staff can be contacted via the RUH switchboard.

The RUH "Hot Lab"
The RUH Hot Lab processes blood cultures, CSFs, and specimens for urgent microscopy culture and sensitivity. It does not process faeces, sputa or specimens at high risk for category 3 or 4 organisms(see list below). All other specimens including virology specimens, are processed in the HPA laboratory in Bristol

Transport leaves for the HPA laboratory in Bristol as follows:
Monday - Friday: 09.00, 13.00, 15.00 and 17.00 hrs
Saturdays: 09.00 hrs
Sunday: 09:00 hrs only for MRSA screening swabs & C Diff specimens only.

For other specimens, please note that there is no regular transport at weekends after 9am on Saturday. The next transport is at 9am on Monday morning, except on Bank Holidays when it is 9am on the next full working day.

If samples need urgent transportation to the HPA laboratory in Bristol out of hours, this should be arranged with the on-call Biomedical Scientist. Packaging of specimens must be compliant with the latest regulations.

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5.2 Specimen Type Required

All specimens must be received in appropriate containers, sealed in a plastic bag with the request form in a separate compartment. ALL sections of the request form MUST be completed and relevant clinical information provided. Incomplete data may result in significant delays and/ or inappropriate processing.

Details of specimen type required are available in the Bristol HPA Users' Manual which can be found on the RUH intranet / internet.

Bottles and containers that are unavailable on the ward can be obtained from Pathology stores on 01225 824724

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5.3 Request Forms

Most Microbiology tests are requested on a blue Microbiology form

Virology forms (white with black writing) are available for Virology tests.

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5.4 Urgent Specimens

Urgent specimens will be processed in the on-site laboratory where possible, but please note the following:

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5.5 Microbiology Results Enquiries

As soon as results are completed and authorised they are available on the Ultra Laboratory computer system. The turnaround times for microbiology specimens are given in the HPA User Manual. If a result is required on an incomplete test, this should be requested from the Bristol laboratory on 0117 342 2514 (Microbiology) or 0117 342 5012 (Virology). Other results and clinical advice can be obtained through the Microbiology secretary on 01225 825428.

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5.6 Infection Control Advice

Infection Control policies are available on the intranet via the following link: Intranet Infection Control Policies

The Infection Control Nurses are available on site between 9am and 5pm on 01225 825450 or 01225 42 8331 and bleep 7991.

Out of hours infection control advice can be sought from the on call Medical Microbiologist via the RUH switchboard (01225 42 8331).

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5.7 Clinical Advice

Empiric antibiotic guidelines (including antibiotic assay guidelines) are available:

A - Z of Clinical Guidelines.

Antibiotic Guideline: Empirical Treatment of Infections in Adults (Internal link)

The Microbiology Consultants are very happy to discuss complex clinical queries but would be grateful if teams could review results and discuss management within the hierarchy of their own clinical teams before telephoning.

A Duty Medical Microbiologist is available on-site between 9am and 5pm. Call 01225 825428.

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5.8 On-Call service

An On-Call Medical Microbiologist is available out of hours via the RUH switchboard.

Note that the on-call Microbiologist may not be an RUH based doctor. Please consider whether your query could wait to be discussed with an RUH based Microbiologist the following day. If it does require urgent discussion, ensure that you have all the necessary information to hand before phoning the on-call doctor.

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5.9 High Risk Specimens

The Infection Control Committee advocates a UNIVERSAL PRECAUTIONS policy but specimens from patients known or clinically suspected to be infected with HIV, Hepatitis B or C virus should have a yellow "Danger of Infection" sticker attached to the specimen container and request form.

This applies to all the following potentially infected body fluids:

Unnecessary confidential information e.g. HIV, Hepatitis B or C positive, should not be disclosed on the request form.

Specimens from patients known or clinically suspected to be infected with other Hazard Group 3 (e.g. Mycobacterium tuberculosis, Salmonella typhi or S.paratyphi, Coxiella burnetti (Q fever), and Brucella spp should have a "Danger of Infection" sticker attached to the specimen container and request form. This also applies to patient potentially infected with Hazard group 4 infections eg viral haemorragic fever or CJD, but samples from patients with these conditions should be discussed with laboratory staff ideally before they are taken, but certainly before they are sent to the laboratory. Please refer to relevant Infection Control Policies on the Intranet.