Referralto OTHER Laboratories

referRALTO OTHER Laboratories

CONTENTS

0Introduction

0.1.Scope and purpose of document

0.2.Clinical significance

0.3.Intended use of procedure

0.4.Responsibility

0.5.References

0.6.Definitions and abbreviations

0.7.Related Documents

0.8.Health and Safety

Risk Assessment

1evaluation of selecting referral laboratories

2referral laboratory record

3SPECIMEN PREPARATION:

4REFERRAL LABORATORIES /TESTS REFERRED

4.1.Acanthamoeba spp

4.2.Anaerobes

4.3.Antimicrobial resistance

4.4.Antimicrobial levels

4.5.Bordetella pertussis PCR

4.6.Burkholderia cepacia Identification

4.7.Carbapenamases confirmation

4.8.CJD investigation

4.9.Clostridium difficile

4.10.Corynebacterium spp

4.11.Cryptococcal Antigen

4.12.Chlamydia trachomatis

4.13.CSF volumes for referral

4.14.E.coli 0157 / Verocytotoxin Ecoli’s

4.15.Flucytosine assays

4.16.Gram Neg Bacilli identification

4.17.Isoniazid Levels

4.18.Haemophilus influenzae

4.19.Helicobacter PCR

4.20.Listeria monocytogenes

4.21.MRSA

4.22.Mycology Reference Laboratory

4.23.Mycoplasma genitalium

4.24.(M.pneumoniae/ M.hominis and U.urealyticum)

4.25.Mycobacterium tuberculosis

4.26.Mycobacterium tuberculosis PCR on CSF’s& Pleural Fluids

4.27.PCR for Mycobacterium sp (tissue samples)

4.28.Mycobacterial Interspersed Repetitive Unit (MIRU) Typing for epidemiological typing of M. tuberculosis complex isolates

4.29.Neisseria gonorrhoeae

4.30.Neisseria meningitidis

4.31.Parasites and amoeba

4.32.Pneumocystis jiroveci ( formerly carinii )

4.33.Quantiferon levels

4.34.PCR ( 16s/ 18s) Bacterial and Fungal Screening – CSF/Tissue/Sterile Fluid

4.35.Salmonella sp

4.36.Shigella sp

4.37.Streptococci sp

4.38.Streptococcus pneumoniae

4.39.Staphylococcus aureus – PVL Toxin

4.40.Staphylococcus aureus – TSST Toxin

4.41.Synergy testing

4.42.Teicoplanin levels

4.43.Viral PCR

4.44.Whipples disease.

5Recording specimens referred on iLAB

6On return of the report from the Referral Laboratory

7maintaining a record of all specimens referred

8monitoring the return of reports from the referral LABORATORY

9Reviewing referral laboratories

0Introduction

0.1.Scope and purpose of document

• To ensure the safe and timely transport and delivery of specimens to referral laboratories for confirmatory tests and/or investigations which are not currently performed in the Microbiology Laboratory, University Hospital Limerick.
• To ensure safe and timely return of referral laboratory reports to the Microbiology Laboratory,

UniversityHospitalLimerick.

0.2.Clinical significance

Referral laboratories allow clinicians access to a wider range of tests (often highly specialised tests) that are not available in the local laboratory. Specimens tested locally can be sent to referral laboratories to confirm the results of the Microbiology Laboratory, UniversityHospital, Limerick.

0.3.Intended use of procedure

• The Microbiology Laboratory, University Hospital, Limerick is responsible for referring specimens to external laboratories for confirmatory testing and where the test required is not performed within the UHLPathology Department.
• The intended use of this procedure is to ensure specimens sent to referral laboratories are handled efficiently.

A record of all referral results or a summary of same shall be entered on iLAB on receipt and the ‘external’ report forwarded to the requesting location.

0.4.Responsibility

• It is the responsibility of the Senior Medical Scientist in the CSF/Blood culture area to ensure that this procedure, which has been approved by the Microbiology Management Team, is implemented and maintained.

• It is the responsibility of all laboratory staff to ensure that samples arriving at the laboratory for referral to external laboratories are treated appropriately to ensure optimum sample quality on arrival at the referral laboratory.
• The Medical Scientist(s) in each area is responsible for processing samples for referral to external laboratory using the appropriate transport method, as per LP-L-MIC-POST
• The Medical Scientist in the appropriate area is responsible for reviewing reports prior to results being entered on iLAB, as per section 5 below.
• The Medical Scientist in a particular area is responsible for relaying reviewed positive results to the requesting clinician/source AND to the Consultant Microbiologist.
• The Consultant Microbiologist will be available to provide advice in relation to appropriateness of requests to clinicians; and for the selection of the appropriate referral laboratories.
• The Consultant Microbiologist will review all reports returned from the referral laboratory and will be responsible for provision of clinical advice following receipt of positive referral reports.

0.5.References

0.5.1. Laboratories at HPA Centre For Infections, Colindale

0.5.2.ISO 15189:2012 – 4.5 Examination by referral laboratories

0.5.3.IATA Dangerous Goods Regulations (GDR)

0.6.Definitions and abbreviations

Hays DX: Hays DX offers a range of services which are specifically designed to meet the needs of the Health Sector, ranging from delivery of mail, patient records and publications, to highly specialised specimen packaging and delivery. It is the system in use in the Microbiology Clinical Laboratory.

FasTrack: FasTrack is Ireland’s same day National Courier Service. FasTrack uses IarnrodEireann intercity trains to take an item between cities and towns. It then employs vans to deliver your parcel to its destination address.

EMS:EMS/SDS is a courier service of An Post. EMS/SDS is the distribution company in Ireland, offering guaranteed courier and daily delivery services to national and international destinations.

IATA:International Air Transport Association.

CSFCerebrospinal Fluid

CJDCreutzfeldt-Jakob disease

PCRPolymerase Chain Reaction

HPAHealth Protection AgencyUK

0.7.Related Documents

QF-L-MIC-AUDSCHTATMicrobiology Audit Schedule -Test Turnaround Time

LF-L-MIC-CJDCJD Questionnaire

LI-L-MIC-QUANTIFERON Referring Samples for Quantiferon

LP-L-MIC-CSFCJD Investigation of CSF for Creutzfeldt-Jakob disease

LP-L-MIC-MPCR Meningococcal/ Pneumococcal /BHSB/ Haemophilus influenzae PCR

LP-L-MIC-POST Procedure for Transporting Pathological Specimens / Microbial Isolates to External / Referral Laboratories

LP-L-MIC-SPECRECSpecimen reception

MF-L-MIC-REFLReferral Laboratory Information Form

MF-L-MIC-REFLAB1Microbiology Laboratory Referral Laboratory Information

MF-L-MIC-REFLAB2Microbiology Laboratory Referral Laboratory Information Update

PP-A-GEN-REQFRMSPLB Pathology policy On Request Form Completion & Specimen Labelling

LF-L-MIC-WFELOGDaily Log of WFE Performance

HSE 30 HSE National Financial Regulations 2006

REF-1EARSS REFERAL FORMS

REF-2Irish salmonella reference laboratory reference Form

REF-3Irish Meningitis and Meningococcal Referral Form

REF-4Verotocytotoxin E coli referral Form

REF-5Scottish Mycobacteria Reference Laboratory Form

REF-6Micropathology LTD Request Form

REF-7NMRSAL INVESTIGATIONS REFFERAL FORM

REF-8Anaerobic Reference Laboratory

REF-10Haemophiliussp referral Form

REF-13Neisseria gonorrhoeae referral Form

REF-14Mycoplasma genitaliumReferral Form

REF-15National Mycobacterium Reference Laboratory

REF-29HPA - Listeriasp Referral Form

REF-30RSIL Atypical Pneumonia Unit

REF-31Staph aureus toxin

REF-32Streptococcus & Diphtheria Unit

REF-33Burholderia sp Referral Form

REF-40HPA Healthcare pathogens – Single isolate

REF-44Diagnostic Mycology Testing Referral form, Y2

REF-45Parasitology Request Form, Hospital of Tropical Diseases

REF-46IMRL Fax Form for Culture Dispatch

REF-47IMRL Culture Request Form

REF-48L3 – Helicobacter Referral Form

REF-49CPE / CRE Request Form - Galway

0.8.Health and Safety

All manipulations should adhere to good laboratory practice and be in accordance with recommended safety procedures for that biological hazard category.

Risk Assessment

IF IN ANY DOUBT PLEASE CONSULT A SENIOR MEMBER OF STAFF

Key

B= Biohazard / risk of infection. Wear gloves and protective clothing.

In all circumstances;

• Wear protective clothing (laboratory coat, correctly and completely fastened and disposable gloves) at all times when handling biological materials.
• Wash hands thoroughly after handling any substances or after contact with biological materials.
• No smoking, drinking, eating, or application of make-up in designated laboratory areas.

1evaluation of selecting referral laboratories

1. Criteria for selection of a referral laboratory should take into account test availability, sample stability, transport requirements, cost, prior dealings with referral laboratory and stated test turnaround times.
2. Information regarding the accreditation status of the referral laboratory and it’s participation in a relevant EQA scheme should be sought.
3. Service Level agreements are set up between microbiology and the relevant referral laboratory Ref. MF-L-MIC-SLA-XXX. Laboratory Management ensures that there is no conflict of interest, by ensuring compliance with the HSE National Financial Regulations Ref: HSE 30on Q-Pulse
4. The referral laboratory must be accredited. In the event that the referral laboratory is not accredited, EQA and IQC reports must be provided to demonstrate competence prior to referral of requests.
5. In the event of an accredited laboratory test having to be referred to a referral laboratory, the process needs to be managed via Change Control and the following contingency plan must be in place:

• A service level agreement must in place with the referral laboratory.
• The referral laboratory must be accredited. In the event that the referral laboratory is not accredited, EQA and IQC reports must be provided to demonstrate competence prior to referral of requests.
• Service Users must be notified
• There should be a disclaimer on the report that the test is not an accredited test.

1. Referral laboratories are monitored as described in section8.

2referral laboratory record

A record of all referral laboratories is available on qpulse in the supplier module and in section 4 below.

3SPECIMEN PREPARATION:

1.1Refer to section 4 below for correct specimen type and request form for referral test.

1.2Ensure specimen is correctly labelled with a discipline specific label e.g. CSF’s MB labels etc

Ref: PP-A-GEN-REQFRMSPLB

LP-L-MIC-SPECREC

1.3Seal the specimen i.e. EDTA bottle, agar slope, agar plate etc. with Para film.

1.4Record details on iLAB see section 4.

1.5Place the specimen in a sealed biohazard bag. (Do not place the request card in the Biohazard bag). Wrap the biohazard bag in bubble wrap.

1.6Place in the hard plastic container. Ensure that the absorbent material supplied is present.

1.7Place hard container in the cardboard box provided. The request card is put into the box but outside of the plastic container.

1.8For postage details refer to LP-L-MIC-POST.

4REFERRAL LABORATORIES /TESTS REFERRED

4.1.Acanthamoeba spp

1. contact lens and/or wash fluids

1. corneal scrapes

1. Dry swabs of Corneal scrapings

1. submitted cultures

4.2.Anaerobes

4.3.Antimicrobial resistance

4.4.Antimicrobial levels

4.5.Bordetella pertussis PCR

4.6.Burkholderia cepacia Identification

4.7.Carbapenamases confirmation

4.8.CJD investigation

1. Freeze the CSFupon receipt.
2. Fax CJD questioner to Beaumont for review. Only process as below when confirmation received from Beaumont
3. Contact Polar ice at 057 8623860 order number 121931to order dry ice. Establish when dry ice will be delivered.
4. Contact Des the courier at 086 2512476 or 061-364057 to collect the sample and transport it to Beaumont (Neuropathology). Usually the day the dry ice is delivered or the next day depending on time of dry ice’s arrival.
5. Seal the sample with parafilm.
6. Package the sample using the triple packaging as normal; Use one of the Serosep containers under the CSF bench.
7. Place the box in the polar ice Styrofoam insulated box covering the box with the dry ice.
8. Seal the Styrofoam box with sellotape. Label the box with the following:
9. From “Microbiology” label
10. to “Neuropathology “ label
11. Place a Diagnostic sample sticker on the box( Stickers on postage file on blood cultures)
12. Ensure that the “to MWHB” labels are removed.

4.9.Clostridium difficile

4.10.Corynebacterium spp

4.11.Cryptococcal Antigen