GREATER GLASGOW & CLYDE
CLINICAL MYCOLOGY
User Manual
Reviewed: November 2013
MANAGEMENT PROCEDURENUMBER / VERSION / MP015v2
DATE OF ISSUE / 12/12/2013
REVIEW INTERVAL / 2 Years
AUTHORISED BY / Dr G Shankland
AUTHOR / Dr G Shankland
COPIES 2 / Master File in Q-Pulse
LOCATION OF COPIES 1 / Staffnet Intranet Site
2 / GG&C Internet Site
DOCUMENT REVIEW HISTORY
All review / revision details are available in Q-Pulse
CONTENTS
1. Introduction 3
2. Location 3
3. Normal Laboratory Hours 3
4. Staff 4
5. Enquires and Advice 4
6. Sample Request Forms 5
7. Specimen Collection and Packaging 5
8. Storage and Transport 7
9. Reporting 7
10. Services Available & Turnaround Times 8
1. INTRODUCTION
Clinical Mycology operates a C.P.A. accredited laboratory providing a comprehensive, modern diagnostic service including PCR for diagnosis of dermatophyte infections in addition to microscopy, culture, identification, susceptibility testing and antigen detection of clinically important fungi.
This user manual provides an outline of the services provided by Clinical Mycology for the Greater Glasgow & Clyde area and throughout Scotland, both in primary and secondary care.
Every effort is made to provide a service of the highest quality and performance is assessed regularly by a system of internal audit and by participation in National External Quality Assurance Schemes.
2. LOCATION
Clinical Mycology is part of the Department of Microbiology situated in the Laboratory Medicine and Facilities Management Building, Southern General Hospital, Glasgow.
The postal address, telephone and fax numbers of the laboratory are:
Microbiology Department
Laboratory Medicine & Facilities Management Building
Southern General Hospital
1345 Govan Road, Glasgow G51 4TF
Telephone: 0141 354 9132
Facsimile: 0141 232 7977
3. NORMAL LABORATORY HOURS
Weekdays………………...8.45 – 17.00
Saturdays…………………Emergency Service only, by arrangement
Sundays…………………..Emergency Service only, by arrangement
Public Holidays…………. .Emergency Service only, by arrangement
4. STAFF
The Clinical Mycologists are supported by a dedicated team of Biomedical Scientists, Technicians, Ancillary and Secretarial Staff.
CLINICAL MYCOLOGY
Specialist Mycology Laboratory
Consultant Clinical Mycologist
Extension
Dr. Gillian S. Shankland 0141 354 (8)9153
BMS
Mrs. Lynn Brown 0141 354 (8)9148
Mr. Robert Dunsmuir 0141 354 (8)9148
Secretaries 014 1354 (8)9132
5. ENQUIRIES AND ADVICE
For routine specimen enquires phone the Specialist Mycology Laboratory:
0141 354 9148
The Consultant Clinical Mycologist is available to provide advice on choice of antifungals, clinical significance of results, investigation of patients with undefined sepsis or pyrexia, appropriateness of samples and their collection or any other mycological problem. Please feel free to consult her.
For urgent specimens it would be helpful to notify the Clinical Mycology Laboratory in advance. If this is not possible please include a page number or telephone number on the request form for notification of results.
If a specimen is required to be investigated OUTWITH NORMAL HOURS: please notify Clinical Mycology in advance. A senior member of staff is required to approve the test and will make the necessary arrangements.
Please note that it is the responsibility of the requesting clinician (and not the laboratory), to arrange transport of emergency samples.
6. SAMPLE REQUEST FORMS
Request forms should contain the following information:
o patient’s name
o address and the ward or referring laboratory details
o The patient’s date of birth (essential for proper functioning of the laboratory computer systems)
o CHI number
o Type of sample (e.g. blood, sputum, referred culture)
o Site of sample (e.g. yeast ex blood, HVS)
o Date and time of sampling
o Antifungal treatment: current or recent
o Brief clinical history
o Current location of patient
o Contact no./page (facilitates telephoning of result if necessary)
o Test/s required
Failure to provide essential patient details, in particular ward, GP or microbiology laboratory location may 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 and label both the sample and form with a "Danger of Infection" label.
7. SPECIMEN COLLECTION AND PACKAGING
Always label the sample with the patient's name, the ward/unit in addition to the date and time of sampling. All mycology samples should be handled and transported with care as they are a potential source of infection. Customized polythene bags with separate compartments for the sample and request form should always be used for specimen transport.
If samples are sent through the Royal Mail they must comply with current postal regulations.
http://www.staffnet.ggc.scot.nhs.uk/Info%20Centre/Health%20and%20Safety/Corporate%20Health%20and%20Safety/Documents/TransportofSpecimenPolicyJan2009.pdf
If you wish to use the DX courier system to transport specimens to the laboratory the number for Clinical Mycology is:
Bacteriology Department Southern General Hospital 1345 Govan Road, Glasgow G51 4TF DX6490400 Exchange Cardonald 90G
As some of the fungi in respiratory secretions are present in the normal environment care with sterility should be taken at every stage. Commensal organisms such as Candida spp may overgrow moulds if the sample is left too long before processing, therefore the faster it can reach the Specialist Mycology Laboratory the better.
If a biopsy is taken it should not be placed on blotting paper in the container unless the blotting paper is STERILE. A drop of sterile distilled water may be placed in the sterile transport container to prevent the tissue from dying out.
5mls of serum is recommended for serological tests. Please ensure samples are labelled with the appropriate sample times.
Samples from superficial sites
Always label the sample with the patient's name, the ward/unit/practice in addition to the date and time of sampling. All mycology samples should be handled and transported with care as they are a potential source of infection. Customized polythene bags with separate compartments for the sample and request form should always be used for specimen transport.
The most suitable method of collection and transporting specimens of skin, hair and nail is by folding into a slip of black or dark blue paper approximately 15cm square or a commercial specimen packaging kit (MycoTrans is recommended).
This method of collection has several advantages.
· The specimen can dry out during transport to the laboratory and this reduces bacterial contamination.
· The laboratory worker can process and conserve the specimen without transferring to another container.
· A large number of specimens can be posted in a single envelope.
Please note
· Specimens transported in screw capped bottles or plastic containers do not conform to postal regulations. They also have to be transferred before processing and valuable sample may be lost as it is often difficult to find and remove small fragments of material from large containers. Postage of such specimens is also unnecessarily expensive.
· Specimens placed between glass slides pose a hazard to postal workers and laboratory staff and the specimen is often unable to be processed.
Scalp:
From suspected areas – usually evident as alopecia – collect broken hairs complete with roots. Only the first 5 – 6mm of hair is of any value in most instances.
Skin:
On glabrous skin, the advancing edge of the lesion provides the most satisfactory specimen. For feet and hands – scrape into the intact skin – the loose accumulation of soggy skin between toes is seldom of value. If vesicles are present, submit the whole top.
Nail:
If possible, provide a specimen that excludes the distal edge and cut well back through the entire thickness of the nail. The subungual debris taken from
the most proximal part of the infection may be useful and can be submitted as a separate specimen. (Reference; Roberts, Taylor & Boyle, 2003: British Journal of Dermatology 148; 402-410)
8. STORAGE AND TRANSPORT OF SAMPLES
Some samples from microbiology laboratories outwith Greater Glasgow, and general practitioners are delivered by the Royal Mail other samples are delivered by taxi or van service to the specimen reception in Microbiology. Although most samples are delivered to ensure that they are processed on the day they arrive, some specimens miss earlier deliveries and may not be processed on the same day.
Please ensure all high risk samples are clearly labelled.
In order to guarantee processing of urgent samples on the same day, it is advisable to telephone details to the laboratory.
Please note that it is the responsibility of the requesting clinician (and not the laboratory), to arrange transport of samples.
9. ROUTINE REPORTING PRACTICE
Results are telephoned by a Clinical Scientist or Biomedical Scientist if the clinical history and/or pathogens isolated suggest a potentially serious infection, or if specifically requested. Please note that a request for an urgent telephoned result refers to microscopy and therefore, you must indicate if the culture result should also be phoned. Positive microscopical examination results are usually issued within 24hr from receipt of sample. Due to the slow growing nature of dermatophyte fungi, specimens are incubated for 3 weeks before a final report is issued.
Computer generated reports are available by 3pm and are collected by porters and taken to the mail room where they are distributed to hospital wards and clinics or via the Royal Mail. Urgent interim results may be requested by telephone
Authorised results may also be viewed through the SCI store system.
This document is available on the intranet
10. SERVICES AVAILABLE AND TURNAROUND TIMES
The turnaround time is taken as from when we receive the specimen to when the report is issued. The majority of specimens can expect to be processed within these time periods. However, several factors may lead to delay in processing a specimen and thus it is inevitable some specimens will be outwith these turnaround times.
Additional tests may be requested up one week after receipt by Clinical Mycology.
Specimen or Investigation Turnaround Time
Microscopical examination 2 days
PCR for Trichophyton rubrum 7 days
Dermatophyte culture 7 to 21 days
Yeast identification 1 – 5 days
Mould culture Identification 2 - 5 days
Biopsy, body fluids & pus samples 2 – 5 days
Aspergillus antigen (galactomannan) 2 – 5 days minimum 350µl serum or 2ml clotted blood or broncho-alveolar Lavage fluid
Cryptococcus antigen latex agglutination 1 day
minimum 350µl CSF or serum or 2ml clotted blood
Cryptococcus antigen ELISA 1 day
minimum 60µl CSF or serum or 1ml clotted blood
Culture of respiratory secretions 5 – 7 days
Culture of body fluids 5 – 7 days
Culture of ear swabs, 2 – 5 days
Susceptibility testing 2 days
Amphotericin, anidulafungin, caspofungin, clotrimazole, fluconazole, flucytosine, itraconazole, ketoconazole, micafungin, miconazole, nystatin, posaconazole, voriconazole
Antifungal drug level monitoring
These samples should be sent directly to Biochemistry Department at Southern General Hospital who perform the tests by HPLC.
Antigen & antibody detection of endemic mycosis are not preformed by Clinical Mycology GG&C. Please send your samples directly to the laboratories in the UK who do these tests these are Mycology Centre, Leeds 01133926787 or HPA Mycology Laboratory Bristol 0117342 5028.
Histoplasma & Coccidioides serum or CSF 500µl or 2ml clotted blood
Blastomyces & Paracoccidiodes 100µl serum or 1ml clotted blood.
Telephone reporting of results
· Requests marked urgent
· New positive Cryptococcus antigen or rising titre
· Positive microscopy of CSF
· Positive Aspergillus antigen results
· Antifungal resistance in clinically significant isolates
MP015v2 / Specialist Mycology Laboratory Hospital User Manual / Page 1 of 8