GREATER GLASGOW & CLYDE
CLINICAL MYCOLOGY
Specialist Mycology Laboratory
Hospital
User Manual
Reviewed: May 2010
GREATER GLASGOW & CLYDE CLINICAL MYCOLOGY SERVICE
MANAGEMENT PROCEDURENUMBER / VERSION / MP015v1
DATE OF ISSUE / 18/5/10
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
- Introduction3
- Location3
- Normal Laboratory Hours3
- Staff 4
- Enquires and Advice4
- Sample Request Forms 5
- Specimen Collection and Packaging5
- Storage and Transport6
- Reporting6
- Services Available & Turnaround Times7
1. INTRODUCTION
The Clinical Mycology Department operates a C.P.A. accredited laboratory providing a comprehensive, modern diagnostic service including drug level monitoring in addition to microscopy, culture, identification, susceptibility testing, serological diagnosis and antigen detection of clinically important fungi.
This user manual provides an outline of the services provided by The Specialist Mycology Laboratory. The Department provides mycology services for the Greater Glasgow & Clyde 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
The Specialist Mycology Laboratory is situated in the South Laboratory Building, Yorkhill Hospital .
The postal address, telephone and fax numbers of the laboratory are:
Clinical Mycology
South Laboratory Building,
Yorkhill Hospital,
Glasgow G3 8SJ
Telephone: 0141 201 0715
Facsimile: 0141 201 0413
3. NORMAL LABORATORY HOURS
Weekdays………………...8.30 – 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
Head of Department & Consultant Clinical Mycologist
Extension
Dr. Gillian S. Shankland201 (8)0024
Principal Mycologist
201 (8)0417
BMS
Mrs. Lynn Brown201 (8)0715
Mr. Robert Dunsmuir201 (8)0715
Secretary
Mrs. Karen Tolland201 (8)0419
5. ENQUIRIES AND ADVICE
For routine specimen enquires phone the Specialist Mycology Laboratory:
0141 201 0715
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 Specialist 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 the Specialist Mycology Laboratory in advance. A Clinical Scientist 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:
- patient’s name
- address and the ward or referring laboratory details
- The patient’s date of birth (essential for proper functioning of the laboratory computer systems)
- CHI number
- Type of sample (e.g. blood, sputum, referred culture)
- Site of sample (e.g. yeast ex blood, HVS)
- Date and time of sampling
- Antifungal treatment
- Brief clinical history
- Current location of patient
- Contact no./page (facilitates telephoning of result if necessary)
- 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.
or from the laboratory.
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 antifungal assays and serological tests. Please ensure samples are labelled with the appropriate sample times.
8. STORAGE AND TRANSPORT OF SAMPLES
Some samples from microbiology laboratories outwith Greater Glasgow, and general practitioners are delivered by the Royal Mail directly to the Specialist Mycology Laboratory. Other samples are delivered by van or taxi service to the specimen reception in Yorkhill Microbiology. They are then delivered to the Specialist Mycology Laboratory and 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.
Fungi are generally slow growing and may require extended incubation or specific conditions to encourage them to produce characteristics that allow for their identification.
Computer generated reports are available by 3 pm and are collected by Yorkhill porters or taken by secretarial staff 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.
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 InvestigationTurnaround Time
Microscopical examination 2 days
PCR for Trichophyton rubrum7 days
Dermatophyte culture7 to 21 days
Yeast identification1 – 5 days
Mould culture Identification2 - 5 days
Wound swabs, body fluids & pus samples2 – 5 days
Aspergillus antibody 2 days
minimum 100µl serum or 200µl clotted blood
Aspergillus antigen (galactomannan)2 – 5 days minimum 350µl serum or 2ml clotted blood or broncho-alveolar Lavage fluid
Candida antibody2 days
minimum 100µl serum or 200µl clotted blood
Candida antigen (mannan)2 –5 days minimum 350µl serum or 2ml clotted blood
Cryptococcus antigen latex agglutination1 day
minimum 350µl CSF or serum or 2ml clotted blood
Cryptococcus antigen ELISA1 day
minimum 60µl CSF or serum or 1ml clotted blood
Culture of respiratory secretions5 – 7 days
Culture of body fluids5 – 7 days
Culture of ear swabs,2 – 5 days
Culture of high vaginal swabs2 – 5 days
Susceptibility testing2 days
Amphotericin, anidulafungin, caspofungin, clotrimazole, econazole, fluconazole, flucytosine, itraconazole, ketoconazole, micafungin, miconazole, nystatin, posaconazole, terbinafine, voriconazole
Antifungal drug level monitoring1 – 2 days
For antifungal assays please supply 5ml of serum taken and the appropriate times and labelled accurately. These samples should be sent directly to Biochemistry Department at Gartnavel General Hospital who perform the tests by HPLC.
Amphotericin
IV1 – 2 hours post dose
The measurement of amphotericin levels are rarely indicated, as there is no correlation with blood levels and renal impairment. There are no recognised optimal levels for specific fungal infections.
Fluconazole
Oral2 hours post dose
IV30 minutes post dose
The measurement of fluconazole levels are seldom indicated and Clinical Mycology should be contacted before sending samples.
Flucytosine
Oralpre-dose and 2hours post dose
IVpre-dose and 30 minutes post dose
Range trough 20 - 40mg/L, peak 70 - 80mg/L
Itraconazole
Oral and IVpre-dose
These are being preformed by HPLC at Biochemistry, Gartnavel General Hospital however authorisation is preformed and clinical comments added by Clinical Mycologists.
Voriconazole
Oral2 hours post dose
IV1 hour post dose
No established range but expected range is 0.25 - 6.0mg/L. Levels over 10.0 mg/L should be avoided and levels over 6.0mg/L may lead to liver toxicity.
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 0117 342 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
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