Download clinical mycology - NHS Greater Glasgow and Clyde

GREATER GLASGOW & CLYDE
CLINICAL MYCOLOGY
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Reviewed: May 2010
GREATER GLASGOW & CLYDE CLINICAL MYCOLOGY SERVICE
MANAGEMENT PROCEDURE
NUMBER / VERSION
MP016v1
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
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Page 1 of 8
CONTENTS
1. Introduction
2. Location
3. Normal Laboratory Hours
4. Staff
5. Enquires and Advice
6. Sample Request Forms
7. Specimen Collection and Packaging
8. Storage and Transport
9. Reporting
10. Services Available and Turnaround Times
11. Other Tests Available
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Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
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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
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
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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
201 (8)0024
Dr. Gillian S. Shankland
Principal Mycologist
201 (8)0417
BMS
Mrs. Lynn Brown
Mr. Robert Dunsmuir
201 (8)0715
201 (8)0715
Secretary
Mrs. Karen Tolland
201 (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.
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Page 4 of 8
6. SAMPLE REQUEST FORMS
Request forms should contain the following information:
o patient’s name
o address and the ward or practice for return report
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. fingernail, toenail, skin, blood)
o Site of sample (e.g. scrape ex groin)
o Date and time of sampling
o Antifungal treatment
o Brief clinical history
o Current location of patient if in 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/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.
 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
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Page 5 of 8
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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
Dermatology and General Practitioner samples are delivered by the Royal
Mail directly to the Specialist Mycology Laboratory or by van or taxi service to
the South Laboratory Building, Yorkhill Hospital.
In order to guarantee processing of urgent samples on the same day, it
is advisable to telephone details to the laboratory.
Please ensure all high risk samples are clearly labelled.
Please note that it is the responsibility of the requesting clinician (and not the
laboratory), to arrange transport of samples.
If samples are sent through the Royal Mail they must comply with current
postal regulations.
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Page 6 of 8
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. 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 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 Investigation
Microscopical examination
PCR for Tricophyton rubrum
Dermatophyte culture
Yeast identification
Mould culture Identification
Wound swabs, body fluids & pus samples
MP016v1
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
Turnaround Time
2 days
7 days
7 to 21 days
1 – 5 days
2 - 5 days
2 – 5 days
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11. OTHER TESTS AVAILABLE
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 antibody
2 days
minimum 100µl serum or 200µl clotted blood
Candida antigen (mannan)
2 –5 days
(minimum 350µl serum or 2ml clotted blood)
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
Culture of high vaginal swabs
2 – 5 days
Susceptibility testing
2 days
Amphotericin, anidulafungin, caspofungin, clotrimazole, econazole,
fluconazole, flucytosine, itraconazole, ketoconazole, micafungin, miconazole,
nystatin, posaconazole, terbinafine, voriconazole
Antifungal drug level monitoring
1 – 2 days
For antifungal assays please supply 5ml of serum taken and the appropriate
times and labelled accurately.
Antigen& antibody detection of endemic mycosis is 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.
MyMM001
Version Number
Author
Issue date
MP016v1
Dermatology and General Practice User Manual,
Clinical Mycology, Greater Glasgow & Clyde
4
Dr. Gillian S. Shankland
12th May 2010
Specialist Mycology Laboratory
Dermatology & General Practice
User Manual
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