A GUIDE
to the
MEDICAL MICROBIOLOGY
SERVICES FOR
WIRRAL UNIVERSITY TEACHING HOSPITALS &
COUNTESS OF CHESTER HOSPITAL
An accredited laboratory, under the
Clinical Pathology Accreditation (CPA) scheme
February 2013 Version 1.0
P Ashcroft
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
CONTENTS
Page
1.
General Information...................................................................................................... 4
2
Daytime Laboratory Hours............................................................................................. 4
BMS On Call Service for urgent tests ............................................................................ 4
On-call service for urgent clinical advice ........................................................................ 4
Key contacts and their telephone numbers / extensions .......................................... 5
3
Medical Microbiology - Principal Services .................................................................. 6
4
'URGENT' Specimens for Microbiological Investigation ............................................ 8
5
Labelling requirements for request forms (PCIS, WROCS , Anglia ICE, Meditech and
Handwritten forms) ..................................................................................................... 9
5.1
Cerner Requesting.................................................................................................. 10
6
Labelling requirements for specimens ..................................................................... 11
7
Standard procedures for the safe collection of specimens ..................................... 12
7.1
Procedure for venepuncture to obtain a specimen of blood .................................. 134
7.2
Procedure for the collection of pus or exudate ........................................................ 14
7.3
Procedure for the collection of screening swabs ..................................................... 14
7.4
Procedures for the collection of specimens, when sexually transmitted diseases are
suspected ............................................................................................................... 15
7.4.1 High vaginal swab .............................................................................................. 15
7.4.2 Low vaginal swab ............................................................................................... 15
7.4.3 Urethral swabs ................................................................................................... 15
7.5
Procedure for the collection of sputum .................................................................... 16
Bronchial Lavage ........................................................................................................ 16
7.6.
Collection of a mid-stream specimen of urine (MSSU) for culture and sensitivity .... 16
7.7
Collection of a specimen of urine from a catheter (CSU) ........................................ 17
7.8
Procedure for the collection of a specimen of faeces .............................................. 17
2
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
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Next review date: February 2014
7.9
Procedure for the collection of a pernasal swab ...................................................... 17
7.10 Aspirates and fluids from normally sterile sites ....................................................... 17
7.11 Cerebrospinal fluid .................................................................................................. 17
7.12 Wound Swabs ........................................................................................................ 18
7.13 Collection of specimens for mycology investigations ............................................... 18
Skin 18
7.12 Blood for Virology/Serology investigations .............................................................. 19
7.13 Swabs for viral investigations .................................................................................. 19
7.14 Fluids and Pus for viral investigations ..................................................................... 19
7.15
Corneal Scrapes .................................................................................................... 19
Collection .................................................................................................................... 19
8.0 Transport of clinical specimens from Wirral ............................................................ 20
8.1 Specimens collected and sent from Arrowe Park Hospital .......................................... 20
8.2
Specimens collected and sent from Clatterbridge General Hospital and Clatterbridge
Cancer Center (CCC) ............................................................................................. 20
8.3
Specimens collected and sent from GP Practices ................................................... 21
8.3 Packaging and transport ............................................................................................. 21
9.0 Transport of clinical specimens from Chester ....................................................... 222
Urgent Specimens – Out of hours ............................................................................... 22
9.1 Packaging and transport ............................................................................................. 23
10
Investigations and Turnaround Times .................................................................... 244
10. Key factors which affect the performance and or result of a Microbiology Test . 455
11
Containers appropriate for the transport of specimens for microbiological
investigations .......................................................................................................... 466
12
REFERENCE RANGES ............................................................................................. 477
13
Routine Referral Laboratories ................................................................................. 488
Appendix 1 – Location of Medical Microbiology Department........................................ 50
3
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
1.
General Information
The Medical Microbiology Laboratory is part of a collaboration between Wirral University
Teaching Hospital NHS Foundation Trust and Countess of Chester NHS Foundation
Trust. The laboratory is located on the Croft Buisness Park Bromborough. The
Laboratory address is:
11 Bassendale Road,
Bromborough,
Wirral.
CH62 3QL
24 hour cover is provided for ALL aspects of infectious diseases.
Daytime Laboratory Hours
Monday - Friday
08.00hrs. – 19:00hrs
Weekend and Bank Holidays – 08:00hrs – 17:30hrs
BMS On Call Service for urgent tests
Monday – Friday
17:00hrs – 08.00hrs the following day
Saturday Sunday
19:00 – 08.00hrs the following day.
The on call BMS can be contacted by telephone from 17:00 on all days
Only Medical staff are given access to the BMS on call (exceptions are other lab staff,
bed coordinator, senior Trust managers).
Contact on-call Biomedical Scientist via switchboard of each Trust
On-call service for urgent clinical advice
Consultant in Medical Microbiology
Between 17.00 – 09.00 Monday – Friday and between 17.00 on Friday and 09.00 on
Monday (weekends), please contact the Consultant Microbiologist on-call via the
switchboard of each Trust Please note that the on-call Consultant Microbiologist should
only be contacted in response to requests from the following categories of personnel:-
4
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Consultants (in exceptional circumstances contact may be made by a registrar if the
patient has been discussed with the consultant in the team, but the consultant is unable
to make the call himself / herself).
Pharmacists
Laboratory staff
General Practitioners
2
Key contacts and their telephone numbers / extensions
Laboratory Results / Enquiries
Monday – Friday
8:00 a.m. – 19:00hrs
Saturday – Sunday 9.00 a.m. – 17.00hrs
Consultant Staff Wirral
01244 362500
Dr John G Cunniffe
0151 482 7696
Dr Kavya Mohandas Clinical Service Lead
0151 482 7694
Dr Dave Harvey
0151 604 7466
Consultant Staff Countess of Chester
Dr Jeremy Gardner
Dr Ildiko Kustos
01244 366788
Lead Consultant
01244 366785
Medical Secretaries for clinical enquiries Wirral
Monday – Friday: 9:00 a.m. - 5:00 p.m.
0151 604 7601/7607
Medical Secretaries for clinical enquiries Countess of Chester
Monday – Friday: 9:00 a.m. - 5:00 p.m.
01244 366773
Laboratory Manager
Mr John Auld
01244 362496
Chief Biomedical Scientists
Mr Peter Ashcroft
01244 362499
Mrs S Bamber
01244 362493
5
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Next review date: February 2014
Mrs Y Gatty
01244 362481
Chief Biomedical Scientists (IT Lead)
Mr I Green
3
01244 363354
Medical Microbiology - Principal Services
Clinical Service
The principal diagnostic laboratory is based at The Croft Business Park, Bromborough. In
addition there is a small satellite laboratory on the Arrowe Park site and The Countess of
Chester site that is mainly used for processing out-of-hours specimens. Access to consultative
and principal diagnostic services outlined below are available on a 24 hour basis.
Diagnostic Service
The department provides a comprehensive microbiological service in medical bacteriology,
mycology, virology, parasitology and serological investigations. Advice on the selection of
appropriate diagnostic specimens, their collection and transport is available.
Results of particular clinical significance are phoned through to the surgery or relevant
medical staff, irrespective of whether the original request is marked as urgent or routine.
Antimicrobial Therapy and Clinical Consultation
When a conclusive microbiological diagnosis has been reached, optimum therapeutic regimens
are reported when necessary. They will be reported as:
Sensitive (S): Implies that the micro-organism is inhibited by the usually achievable
concentrations of the antimicrobial agent when the recommended dosage is used for the
site of infection.
Intermediate (I): Implies clinical efficacy in body sites where the drugs are
physiologically concentrated (e.g. quinolones and  -lactams in urine) or when a higher
than normal dosage of a drug can be used (e.g.  -lactams). This will include microorganisms with antimicrobial agent Minimum Inhibitory Concentrations (MICs) that
approach usually attainable blood and tissue levels and for which response rates may be
lower than for susceptible micro-organisms.
6
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Next review date: February 2014
Resistant (R): Implies that micro-organisms are not inhibited by the usually achievable
concentrations of the antimicrobial agent with normal dosage schedules.
Performance Standards for Antimicrobial Susceptibility Testing; 19th Informational Supplement January 2009: Clinical
Laboratory Standards Institute (CLSI)
The serum concentration of relatively toxic antimicrobials and those used in critical infections
are monitored.
The following empirical (blind / provisional) prescribing regimens can be found in the
Wirral Prescribers’ Guide and The Chester Joint Formulary
(a)
for patients with severe sepsis and
(b)
when the microbiological diagnosis is inconclusive
Teaching and Training
The Department of Medical Microbiology supports scientific and professional training for its staff,
as well as the teaching of science students attending local universities and colleges. It is also
actively involved in providing work experience placements for year 10 and 11 pupils from local
schools. Placements are also given to Co terminus students undertaking the Biomedical
Science degree course at Liverpool John Moores University. The laboratory is also involved in
teaching for the Infection Control Link Nurses course run by University of Chester.
Document control
All documents used in Microbiology are managed electronically using Q-Pulse software (QPulse Version 5 Gael Quality Limited).
Documents are embedded within the system and backed up on Countess of Chester Servers to
protect their integrity.
There are policies, procedures and templates specific to Medical Microbiology as well as shared
directorate documents.
The department are obliged to follow Trust policy and procedures. To avoid duplication some of
these policy and procedure documents are used in place of departmental ones.
The Laboratory is hosted by Wirral University Teaching Hospital NHS Foundation Trust policies
and procedures are located on the intranet.
7
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
4
'URGENT' Specimens for Microbiological Investigation
Biomedical Scientists (BMSs) are available in the laboratory between 08.00hrs and 17:00hrs 7
days a week to process any samples that are considered urgent. The BMS must be contacted
in the laboratory on 01244 362500 with the details of the request.
Members of the public who are dropping off urgent specimens should come to the laboratory at
Bassendale Road (see Appendix 1) before 18:30hrs.
Out of Hours Service / Emergency On-Call Service
Monday – Friday
17:00hrs – 08.00hrs the following day
Saturday - Sunday
19:00 – 08.00hrs the following day.
The on call BMS can be contacted by telephone from 17:00 on all days
Requests for urgent specimens to be processed after 17:00 pm should be directed to the on-call
Biomedical Scientist through switchboard at both Wirral sites or Countess of Chester Hospital.
The following are out-of-hours requests that may be made via Biomedical Scientist: Paediatric MSSUs (Microscopy / Culture /  Direct Sensitivity)
NB Urines should be screened by dipstick by the requestor. BMS staff will only come in to
examine samples that are positive for leucocyte esterase or nitrites.
 Material from Sterile Sites
e.g. Synovial fluid
Peritoneal fluid (eg Ascites)
CSF
 Pus from deep seated abscesses
(Other pus swabs etc contact the Consultant Medical Microbiologist)
 Blood Borne Virus ( HIV, Hepatitis B) screen for pre dialysis patients
 Pus
 Specimens from theatre
Taxis
The Department operates a 24/7 service for urgent specimens see the details above in the
unlikely event that a specimen may not be processed urgently because it has missed the
transport run then a taxi may be required to transport the sample to the Laboratory at
Bromborough.
8
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
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Next review date: February 2014
If the last transport run has been missed please contact the Laboratory to determine
whether transport by taxi or arranging the on call BMS would be best. Taxi specimens
can be accepted in the Micropath Laboratory at Bromborough until 18:30hrs Monday to
Friday or until 16.00hrs Saturday and Sunday.
5 Labelling requirements for request forms (PCIS, WROCS , Anglia ICE,
Meditech and Handwritten forms)
Requests communicated to the laboratory are as follows





PCIS, Cerner and Meditech forms generated at ward level
WROCS and Anglia Ice forms generated by the GP practises
Hand written ‘Blue forms’ from wards
Individual GP hand written request forms.
All verbal requests to the laboratory must be accompanied by one of the above request forms
for the test to proceed.
A request form must accompany all specimens sent to the laboratory using the above ordering
systems. All Locations within each Trust and GP practice should make requests via the
above Order Entry Systems – otherwise results will not be viewable electronically.
The request should clearly state the following information for unequivocal identification of the
patient and specimen:

Patient name (in full – no abbreviations)

Ward, Clinic, or GP name and number/ address

NHS number

Date of Birth (rather than age, if possible)

Sex

Type of specimen

Date and time specimen taken
NB
It is ESSENTIAL that the laboratory knows the date on which a specimen is taken:
processing delayed specimens can yield unhelpful or frankly misleading results and they
may be discarded (eg urine samples dated 2 days prior to day of receipt). When
patients are given a request form and asked to provide a specimen they should be
9
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
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Next review date: February 2014
asked to ensure that the date on which the specimen was collected is given on the
container and the form.

Tests required (specify ‘TB’ if required)

Only request ‘Miscellaneous Microbiology’ if the appropriate investigation is not listed on the
screen

Antibiotic treatment (recent, current or intended)

All relevant clinical details

History of recent foreign travel, if applicable

Risk status, if applicable

Date of onset and duration of illness, particularly for serology

Specify anatomical site from which "wound" specimens were taken

Key epidemiological information, eg for faeces:

request ‘OCP’ (ova, cysts and parasites) if appropriate
5.1
Cerner Requesting
CERNER is a paperless system that will not generate a form. All CERNER requests should have a
status of collected in CERNER before sending to the laboratory. The specimens should be sent
with the printed label on the specimen. All of the above details are necessary to include when
making a CERNER request.
If uncertain about the exact test and terminology, please give a detailed clinical history as this can
help the Laboratory staff to decide the most appropriate investigation
10
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
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G.Mihr
Next review date: February 2014
6
Labelling requirements for specimens

The specimen must be labelled with the patient details as on the request form

The specimen must be labelled with the date of collection.

Please note that unlabelled and mislabelled specimens cannot be processed and will be
discarded.
If the laboratory cannot unequivocally identify the sample and match it to a form, then it will
be discarded.
The laboratory will inform senders by means of an electronic or printed report when a specimen
has been discarded for the above reasons.
In certain circumstances it may be possible to add tests to samples that the laboratory has
already received.
The table below indicates how long samples are kept in the laboratory before disposal.
Requests for extra tests must be received within the sample storage period and must be
accompanied by a request form. Please telephone the laboratory before requesting extra tests
to ensure the sample is available and still viable.
Sample
Time Kept
Faeces
1 week after primary culture. Aliquot of C diff
toxin positive samples – min 3 months
Respiratory samples
1 week after primary culture
Swabs, fluids and aspirates
1 week after primary culture
Urines
48 hours after final report issued
CSF samples
2 weeks after collection (?CJD samples
stored securely in -70C freezer until
Reference Laboratory report is received)
(if 1 month storage required keep with tissue
samples)
Tissue
1 month after primary culture
Stained slides
4 days after primary culture
Post mortem tissue
Until completion of post mortem / coroner’s
report
Policy for disposal under review. Human
11
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Tissue Authority
Mycology Samples
Generally all samples are processed in KOH
MRSA screen swabs
1 week after primary culture
Potable / pool waters
48 hours after final report issued
Pre / post pasteurised milk
48 hours after final report issued
Left over serum from first pregnancy booking
-20C 2 years
Left over serum or plasma (not BBV)
Minimum 3 months - 20C
Sera from positive BBVs
Minimum 2 years at -20C
Left over serum or plasma from
transplantation, post transplantation
donor/recipient sera
Minimum 11 years at -20C
Serum from accidental exposures to blood and
bodily fluids
Minimum 2 years –20C
All clots
Minimum 48 hours at 4C
Unprocessed samples (eg spares
Minimum 48 hours at 4C
Human milk and serum from milk donors
10 years at -80C
7
Standard procedures for the safe collection of specimens
These procedures concern all clinical staff, who are qualified to collect diagnostic specimens
from patients.
N.B. Staff must always follow aseptic techniques when handling blood, body fluids, excretions, or
secretions, even when these have not been specified as infectious.
Objectives
All staff must be aware of the potential physical and infectious hazards, associated with these
procedures, and should therefore collect specimens:
1
being mindful of personal safety, without injury or exposure of themselves and
2
of collective safety, without exposing colleagues who are involved with the handling,
transport and laboratory investigations of specimens, to physical or infectious hazards.
Staff collecting specimens must take care to prevent contaminating themselves, their
environment, the external surfaces of the specimen containers, or the accompanying test
request forms. If gross contamination of the hands with blood, faeces or other biological
fluids is anticipated, then gloves should be worn. Hands should always be washed after
12
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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taking specimens. If splashing into the eyes or on to mucous membranes is anticipated
goggles should be worn.
3
In addition, specimens should be collected aseptically, without allowing contamination by
extraneous and, therefore, irrelevant micro-organisms. Contaminated specimens can
adversely affect the validity of many laboratory results. For example, the microbiological
investigation of contaminated blood or other materials from sites, which are normally
sterile, can commit patients to unwarranted courses of expensive and potentially toxic
treatment.
Before you start
1
Ensure that the lighting conditions are adequate.
2
Select the correct specimen container(s) (see Quick Guide in Section 10), appropriate for
the type of specimen, and keep the container close to the site from which the specimen is
to be obtained.
3
Complete, legibly and fully, all sections of the label on the specimen container and, check
the details on the computer generated request form from WROCS is correct or, where
used, the colour-coded test request forms.
4
If you suspect, or are aware of, an infection with a Hazard Group 3 pathogen (examples of
relatively common Hazard Group 3 pathogens are Hepatitis B virus, Human
Immunodeficiency virus and Mycobacterium tuberculosis), this must be mentioned in the
clinical details sent with the specimen.
5
If you suspect, or are aware of, an infection with a Hazard Group 4 pathogen (Viral
haemorrhagic fevers, eg Ebola and Lassa) do not attempt to collect any specimen. Inform
the Infection Control Doctor for the Trust through switchboard.
When you have finished all waste generated from obtaining a specimen should be
disposed of according to Local Waste Disposal Protocols.
7.1
Procedure for venepuncture to obtain a specimen of blood
Wirral:
http://www.whnt.nhs.uk/document_uploads/Trust_Wide_Policies_Procedures/141%20%20Blood%20Culture%20Collection%20Policy%20%20Procedure-%202012-04%20v2.pdf
Chester:
http://ivy/Documents/Blood%20Culture%20Policy%20(Adults)%202010%20%20why,%20when%20and%20how%20to%20take%20blood%20cultures.docSEPARE
13
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Next review date: February 2014
7.2
Procedure for the collection of pus or exudate
Where there are clinical signs of infection i.e. inflammation, oedema, pyrexia, pain or purulent
exudate, it is preferable to obtain a specimen of pus rather than to take a swab.
Pus or exudate can be drawn up in a syringe and transferred to a universal container.
Taking a Transwab (blue top) or Charcoal swab (black top), remove the swab and gently but
firmly rotate it on the surface directly where infection is suspected. Do not take swabs from
slough or necrotic tissue. Place the swab into the transport medium.
Ensure that the specimen containers are labelled accurately and place, with the completed
request form, in the appropriate pockets of the clear minigrip transport bag for transportation to
the Department of Medical Microbiology.
7.3
Procedure for the collection of screening swabs
Wirral
These swabs should only be taken on the advice of the Community Infection Control Team or to
comply with individual hospital protocols outside of Wirral University Teaching Hospital, e.g. as
for hip/cataract surgery. They are taken to ascertain whether a patient is colonised with
potentially pathogenic bacteria e.g. MRSA, VRE, CPE. If clinical infection is suspected, please
send another swab from ulcers, wounds etc separately for MC&S.
Using Transwabs (blue top) moisten each swab.
Nasal -
rotate the moistened swab gently but firmly around the anterior
nares of each nostril. One swab can be used for both nostrils.
Groin -
rotate the moistened swab gently but firmly over each area. One
swab can be used for both groins
Ensure that the transwabs are labelled accurately and place, with the completed request form,
in the appropriate pockets of the clear minigrip transport bag for transportation to the
Department of Medical Microbiology.
Chester
MRSA swabs
For routine MRSA screens nose and groin swabs are required. Axillae swabs are only tested
from pre-pacemaker insertion patients on CCU and CCS. Swabs for routine MRSA culture are
processed seven days a week. Only swabs from patients on HDU/ITU and emergency
14
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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orthopaedic admissions onto ward 46 are tested for MRSA by
PCR. Swabs from contact screens or any other patient are
only tested by PCR if requested by the Infection Control Nurses. MRSA PCR is only performed
once per day on Monday-Friday and samples MUST be received in Microbiology by 10.30am.
7.4 Procedures for the collection of specimens, when sexually transmitted
diseases are suspected
N.B. If an expanded screen for sexually-transmitted diseases is required, the patient should be
referred to the Department of Genito-Urinary Medicine.
7.4.1 High vaginal swab
Place the patient in dorsal position, supported by a pillow and ask her to bring her heels
together, bend her legs and then draw her heels towards her bottom.
Moisten the speculum with warm water and insert into the vagina to separate the vaginal walls.
Wipe away any excess cervical mucus with a tissue. Using a blue or black topped swab sample as
high as possible into the vault.
Remove speculum and wipe vaginal / vulval area with a tissue.
Ensure that the swab is labelled accurately (see page 5) and place, with the completed request
form, in the appropriate pockets of the clear minigrip transport bag for transportation to the
Department of Medical Microbiology.
7.4.2 Low vaginal swab
Place the patient in dorsal position, supported by a pillow and ask her to bring her heels
together, bend her legs and then draw her heels towards her bottom.
Insert the swab into the lower part of the vagina and rotate gently but firmly.
Ensure that the swab is labelled accurately (see page 5) and place, with the completed request
form, in the appropriate pockets of the clear minigrip transport bag for transportation to the
Department of Medical Microbiology.
7.4.3 Urethral swabs
Avoid contamination with micro-organisms from the vulva or the foreskin. Small swabs are
available for this purpose. The patient should not have passed urine for at least 1 hour. For
males, if discharge is not apparent attempt to "milk" it out of the penis. Pass the swab gently
through the urethral meatus and roll around. Place the swab in the plastic transport sheath
containing the black charcoal-containing Amies medium. Chlamydia: Take this specimen after
the Microbiology swab. Pass the swab through the urethral meatus and gently but firmly roll it
over all the surfaces of the urethral epithelium for 1-2 seconds then withdraw. Place the swab in
chlamydia transport medium, snip off the shaft and screw the cap on.
15
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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Next review date: February 2014
7.5
Procedure for the collection of sputum
The material required is fresh sputum from the lower respiratory tract, expectorated by deep
coughing. When the cough is dry, physiotherapy, postural drainage or inhalation of an aerosol
may be helpful. Saliva and postnasal secretions are not suitable. Early morning specimens for
examination of Mycobacterium species should be collected on at least 3 consecutive days.
Routine sputum microscopy is not worthwhile, but will be done urgently where Staphylococcal
pneumonia is suspected and on patients from the HDU/ITU at Wirral.
Ensure that the specimen container is labelled accurately (see page 5) and place, with the
completed request form, in the appropriate specimen transport bag for transportation to the
Department of Medical Microbiology.
Bronchial Lavage
Please inform the laboratory for urgent processing.
NB. Legionella/ PCP investigations - please contact the Laboratory if required.
7.6. Collection of a mid-stream specimen of urine (MSSU) for culture and
sensitivity
Ensure that the patient is physically clean
If the patient has had the perineum washed in the last 12 hours (ie. has had a shower or bath),
further cleansing of the perineal area before urine collection is not necessary.
If the patient:

is incontinent and / or;

has had their bowels opened since washing the area;
the collection of urine must be postponed until the perineal area has been washed.
Catch the middle portion of the urine in a clean wide-mouth receptacle. Such a receptacle
need not be sterile: any container, previously washed thoroughly with detergent and hot
water and stored dry, is suitable.
A sample of the middle portion of the urine must be poured into a 20ml universal container
(White top Wirral / Red top Chester) with all sections on the label completed.
For Chlamydia investigations, ideally the first catch early morning urine is recommended,
otherwise a first catch urine rather than an MSSU is acceptable.
16
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
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7.7 Collection of a specimen of urine from a catheter (CSU)
When small volumes of fresh urine are required for laboratory investigations, the distal end of
the catheter, or preferably the sampling port if present, must be disinfected with 70% isopropyl
alcohol and urine aspirated with a sterile syringe.
The urine must be transferred to a 20ml universal container (White top Wirral / Red top Chester)
with all sections on the label completed.
If large volumes of urine for laboratory tests are required, these should be obtained aseptically
from the drainage bag.
7.8
Procedure for the collection of a specimen of faeces
When collecting a specimen of Faeces it should be obtained in a convenient container and
transferred into a sterile container with a wooden disposable spatula. The laboratory requires a
“plum sized” portion. Rectal swabs are not a reasonable substitute for faeces.
Faeces for parasites – the recommendation is 3 specimens taken on different days for optimum
recovery.
Ensure that the specimen container is labelled accurately and place, with the completed request
form, in the appropriate specimen transport bag for transportation to the Department of Medical
Microbiology.
For the detection of ova of Enterobius vermicularis (threadworm): with a swab, moistened with
sterile saline, wipe firmly around the anal margin and replace in the transport container.
7.9
Procedure for the collection of a pernasal swab
Gently insert the fine, flexible pernasal swabs (turquoise top) swab horizontally to the back of
the nose. If obstruction is encountered, withdraw and re-insert through the other nostril.
Ensure that the swab is labelled accurately and place, with the completed request form, in the
appropriate specimen transport bag for transportation to the Department of Medical
Microbiology.
7.10 Aspirates and fluids from normally sterile sites
Collect the specimen with a sterile syringe. Transfer a maximum of 20ml into a sterile universal
container. Ensure the cap is tightly screwed on.
7.11 Cerebrospinal fluid
? Meningitis An adequate amount is essential - send at least 2-3ml. This is particularly important if
Mycobacterium tuberculosis infection is suspected where small numbers of organisms may be
present: send 6ml in such cases. Specimens are processed by Manchester Royal Infirmary
17
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Hospital, their policy when requests for exclusion of mycobacterial CNS infection is made requires
at least a 6ml volume of CSF. If there are small volumes then an automated comment will be
produced indicating low volume. The results of microscopy and any positive cultures are always
telephoned.
? Subarachnoid haemorrhage (SAH) If there is a clinical suspicion of SAH and the specimen is
bloodstained send the 1st and 3rd samples so that differential red blood cell counts may be
performed. The results of microscopy and any positive cultures are always telephoned. Always
inform the laboratory that SAH is a possibility by providing the differential diagnoses
7.12 Wound Swabs
Decontaminate the skin to remove as much of the superficial flora. Taking a swab blue or black
topped, remove the swab and gently but firmly rotate it on the surface directly where infection is
suspected. Do not take swabs from slough or necrotic tissue. Place the swab into the transport
medium. If pus is present send as much as possible in a sterile universal container.
7.13 Collection of specimens for mycology investigations
Skin
Patients’ skin and nails can be swabbed with 70% alcohol prior to collection of the specimen,
this is especially important if creams, lotions or powders have been applied. The edges of skin
lesions yield the greatest quantities of viable fungus. Lesions should be scraped with a blunt
scalpel blade. If insufficient material can be obtained by scraping then sticky tape can be
pressed on the lesion then transferred to a clean glass slide for transport to the laboratory
(‘stripping’).
Nails
Good nail samples are difficult to obtain. It should be specified whether the sample is from the
fingernails or toenails. Material should be taken from any discoloured, dystrophic or brittle parts
of the nail. The affected nail should be cut as far back as possible through the entire thickness
and should include any crumbly material. Nail drills, scalpels and nail elevators may be helpful
but must be sterilized between patients. When there is superficial involvement (as in white
superficial onychomycosis) nail scrapings may be taken with a curette. If associated skin
lesions are present, samples from these are likely to be infected with the same organism and
are more likely to give a positive culture.
Hair
Samples from the scalp should include skin scales and plucked hairs or hair stumps. Cut hairs
are not suitable for direct examination as the infected area is usually close to the scalp surface.
Plastic hairbrushes, scalp massage pads or plastic toothbrushes may be used to sample scalps
18
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
for culture where there is little obvious scaling but such samples do not replace a scraping for
direct examination.
7.14 Blood for Virology/Serology investigations
Collect 4 ml of blood in a blood collection tube (usually red or ochre). Heparinised blood may
cause nonspecific reactions in some antigen / IgM assays, but we can use this sample for
routine serology and may lead to delays in reporting results.
For viral DNA/RNA Polymerase Chain Reaction (PCR) tests please send two 4ml EDTA tubes
7.15 Swabs for viral investigations
Moisten the plastic shafted swab with sterile saline never with Viral Transport Media (VTM)
before swabbing. Using a sterile saline moistened plastic shafted swab, swab the area
concerned or vesicles, if vesicles present burst vesicle with sterile needle and swab fluid
released. Snap off the swab tips into VTM.
7.16 Fluids and Pus for viral investigations
Collect as much fluid/pus as possible in a sterile universal container.
7.17 Corneal Scrapes
Collection
A standard operating procedure is available in the Eye Clinic, the following is a summary of this
document.
During Core Laboratory Hours - Mon-Fri 08:45-19:00, Sat/Sun 08.45-17.15
Please contact the Consultant Microbiologist, to discuss the case.
Two corneal scrape kits (containing a bijoux of broth and a glass slide) are kept in the
Ophthalmology Clinic and a further kit is kept in the A+E department. The lab sends these kits
to Ophthalmology at the beginning of each week but if they have all been used further kits can
requested. To request further kits please telephone the Microbiology Department during core
working hours (9am-4pm Monday to Friday)
19
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
8.0
Transport of clinical specimens from Wirral
8.1 Specimens collected and sent from Arrowe Park Hospital
Monday to Friday
From 09.00 am until 14:00hrs. daily there is an hourly collection of
pathology specimens from wards by the portering staff,
After 14:00hrs bleep porters on 2145 to pick up specimens (except
blood cultures which should be sent by pneumatic tube or taken to
Specimen Reception at Laboratory Medicine, Arrowe Park).
The last routine transport from Arrowe Park Hospital to the diagnostic
laboratory at Bromborough is at 17:00hrs.
For URGENT specimens only after 17:00hrs please contact the Oncall BMS, via Arrowe Park Switchboard.
Weekend and Bank Holidays
At approximately 09.00 a.m. a single collection from the wards is
made by the portering staff.
If specimens miss this collection, then they should be sent to the
Arrowe Park Specimen Reception.
There is a scheduled pick-up of specimens, by van, from Arrowe Park
Pathology Laboratory until 15:50hrs.
For URGENT specimens only after the 15.50 transport pickup until 17:00hrs please
contact the Laboratory to determine whether transport by taxi or arranging the on call BMS
would be best.
For URGENT specimens only after 17:00hrs please contact the Out of Hours BMS, via
Arrowe Park Switchboard.
8.2 Specimens collected and sent from Clatterbridge General Hospital and
Clatterbridge Cancer Center (CCC)
Monday to Friday
Specimens need to be taken to the first floor blood science lab at CCC
Drivers will collect CCC and CGH samples every hour from 9am. This
service will run between CGH, APH and Micropath Microbiology lab at
Bassendale on a continuous loop. The last collection from CCC is at
16.30. Any non urgent samples that will not be ready for transport by
20
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
16.30 should be refrigerated and made ready for transport the next
day. Blood Cultures should be placed in the incubator on Sulby ward.
For URGENT specimens only after 17:00hrs please contact the Out
of Hours BMS, via Arrowe Park Switchboard.
Weekend and Bank Holidays
Porters will collect samples from Sulby Ward CCO at approximately
10.15am and again at approximately 12.30pm. Specimen should be
placed in the appropriately coloured biohazard bag in the designated
‘Pick-up Point’ - Specimen refrigerator Sulby awaiting collection for
transport to the laboratory. Blood cultures will be collected at the same
time but should remain in the incubator on Sulby Ward.
For URGENT specimens only after the last transport pickup until
17:00hrs please contact the Laboratory to determine whether transport
by taxi or arranging the on call BMS would be best.
For URGENT specimens only after 17:00hrs please contact the Out
of Hours BMS, via Arrowe Park Switchboard.
8.3
Specimens collected and sent from GP Practices
SRCL Courier Services provide collection of specimens from General Practice for Laboratory
Medicine Monday to Friday only.
8.3 Packaging and transport
Before the specimens are collected by Porters, Couriers, Volunteers, Nursing and Support staff
ensure that specimens and request forms are placed correctly into the mini-grip plastic bags.
Specimens should be placed in the pocket of the plastic bag and grip seal sealed. The request
form should be slid into the sleeve of the plastic bag. The specimen should then be placed in
the large Blue Microbiology specimen bags for collection. All microbiology specimens that are
not collected promptly should be refrigerated.
N.B.
The plastic transport bags, if properly sealed, are designed to contain accidental specimen
leakage from the container. Spontaneous specimen discharge, due to defective materials, is rare.
Most incidents of specimen leakage are due to the fact that neither the container nor the integral
bag strips have been closed properly. If both container and transport bag are closed correctly, the
practice of 'double-bagging', even when an infection with a Hazard Group 3 pathogen is
suspected, does not confer any additional safety advantage and is, therefore, unnecessary
21
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
The containers supplied, comply with standards BS 4851 and BS 5213 for leakage and
spontaneous discharge. Leaked containers frequently result in irreplaceable loss of specimens
and, equally as important, staff to unwarranted hazards of infection.
Members of the public who come across specimen tins containing specimens should
follow the instructions printed on the tin.
9.0
Transport of clinical specimens from Chester
Routine Specimens
Specimens are delivered to the Microbiology Dept. throughout the working day, Monday –
Friday, from Pathology Laboratory reception via hospital transport vans. However, the last
collection of the day leaves there at 17:00hrs. Therefore specimens must have reached the
pathology laboratory reception by the porters, well in advance of this time. Samples will be
collected from Pathology throughout the day on Saturday and Sunday up until 15:30hrs.
Routine samples may be transported to Pathology via the pneumatic air tube system providing
the samples are correctly packaged with secure lids, except for CSF samples.
Urgent Specimens – Normal Hours
If specimens require urgent processing during normal working hours then please contact the
Microbiology Department and inform us of the patient, the ward and any tests required on
Extension 2500. Arrange delivery by telephoning the Porters to request urgent collection of
samples to be taken directly to the Pathology Laboratory Specimen Reception.
If the last transport run has been missed please contact the Laboratory to determine
whether transport by taxi or arranging the on call BMS would be best. Taxi specimen can
be accepted in the Micropath Laboratory at Bromborough until 18:30hrs Monday to
Friday or until 16.00hrs Saturday and Sunday.
Urgent Specimens – Out of hours
Weekdays 17:00-08:00hrs, Saturday, Sunday and Bank Holidays an on-call service is available.
The Biomedical Scientist on-call can be reached by the Hospital switchboard. Clinical advice is
always available from the Consultant Microbiologist (available through the Hospital
switchboard).
22
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Do not send specimens to Microbiology Dept. during “Out
of Hours” unless instructed to do so by the Biomedical
Scientist on-call as there are no facilities for receiving them. The Biomedical Scientist
will arrange collection with the ward.
9.1 Packaging and transport
Before the specimens are collected by Porters, Couriers, Volunteers, Nursing and Support staff
ensure that specimens and request forms are placed correctly into the mini-grip plastic bags.
Specimens should be placed in the pocket of the plastic bag and grip seal sealed. The request
form should be slid into the sleeve of the plastic bag. The specimen should then be placed in
the large Blue Microbiology specimen bags for collection. All microbiology specimens that are
not collected promptly should be refrigerated.
Specimens that are to transported by taxi should be placed in a specimen tin or sealed in an
large envelope.
N.B.
The plastic transport bags, if properly sealed, are designed to contain accidental specimen
leakage from the container. Spontaneous specimen discharge, due to defective materials, is rare.
Most incidents of specimen leakage are due to the fact that neither the container nor the integral
bag strips have been closed properly. If both container and transport bag are closed correctly, the
practice of 'double-bagging', even when an infection with a Hazard Group 3 pathogen is
suspected, does not confer any additional safety advantage and is, therefore, unnecessary.
The containers supplied, comply with standards BS 4851 and BS 5213 for leakage and
spontaneous discharge. Leaked containers frequently result in irreplaceable loss of specimens
and, equally as important, staff to unwarranted hazards of infection.
23
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
10
Investigations and Turnaround Times
All turn around times are stated in working days
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Adenovirus PCR
SER.ADP
BRONCHO-ALVEOLAR
LAVAGE
CSF
Wirral patient Container
and comments
Turnaround
Times
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
2-5 days
EYE SWAB
BRONCHO-ALVEOLAR
LAVAGE
URINE
CSF
URETHRAL SWAB
EYE SWAB
URINE
URETHRAL SWAB
Amoebic Antibodies
SER.AM
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5–7 days
Antenatal Rubella
SER.AN
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Antenatal Rubella &
Syphilis
SER.ANS
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Antenatal Rubella &
Syphilis, Hep B
surface antigen
SER.ANBS
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Antenatal Rubella &
Syphilis, Hep B
surface antigen, HIV
SER.ANBHS
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Antenatal Rubella &
Syphilis, Hep B
surface antigen,HIV,
Hepatitis C
SER.ANBHS
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Anti Staphylococcal
antibody, Serum
SER.AST
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
SER.HC
24
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
Anti Streptolysin-O
antibody, Serum
SER.ASO
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1–4 days
Urgent 2
Hours
Arborvirus (West
Nile)- Flavivirus
SER.AR
8ml clotted blood (Red or
Gold top) clear plastic tube)
& 8ML EDTA (PURPLE
TOP)
REQUEST CAN
ONLY BE MADE IN
CONSULTATION
WITH A
MICROBIOLOGY
CONSULTANT
Aspergillus
Antibodies
SER.AS
8ml clotted blood (Red or
Gold top) clear plastic tube)
Aspergillus/Candida
PCR
SER.ASP
Broncheo-alveolar Lavage
or
SER.CAN
Avian Precipitans
SER.AV
Aspirates and fluids
from normally sterile
sites (joint, ascites,
peritoneal and
pleural fluids)
Atypical Pneumonia
NB mycoplasma
serology is done inhouse. For
Legionella please
4 ml OCHRE capped, clear
plastic blood tube &
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
5-7 days
Urgent-24
Hours
Immunology Request
5-7 days
Broncheo-alveolar Lavage or
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
2-5 days
8ml clotted blood (Red or
Gold top) clear plastic tube)
IMMUNOLOGY REQUEST
10 days
>1ml in a sterile universal
container
>1ml in a sterile universal
container
48 Hours
8ML EDTA (PURPLE TOP)
Urgent Cell
Count/Gram
Stain 1 hour
 Serology: antibody tests
for common pathogens
i.e. Adenovirus,
Coxsackie, Influenza,
Measles, or Mumps
viruses, and
Mycoplasma

Serology: antibody tests
for common pathogens
i.e. Adenovirus,
Coxsackie, Influenza,
Measles, or Mumps
viruses, and Mycoplasma
pneumoniae, selected
2-4 days
25
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
pneumoniae, selected
according to the
presentation of infection
and the clinical
information provided
send urine sample
for ULA
8ml clotted blood (Red
or Gold top) clear
plastic tube
Molecular techniques ie
PCR looking for viruses
require an EDTA blood
tube.
Wirral patient Container
and comments
Turnaround
Times
according to the
presentation of infection
and the clinical
information provided
4 ml OCHRE capped, clear
plastic blood tube
Molecular techniques ie PCR
looking for viruses require an
EDTA blood tube
2-4 days
4 ml LAVENDER capped,
clear plastic blood tube
8ml EDTA (Purple top)

Single 'acute', or 'convalescent', serum
Stored only until paired sample arrives then as below
(except for Chest Infections)
 A pair of 'acute' and
'convalescent' sera:
normally collected 10 to
14 days apart, to
demonstrate, typically, a
4-fold rise in antibody
titre. For some
pathogens a longer
interval (up to 4 weeks)
may be required, in
order to demonstrate a
rise in titre
8ml clotted blood (Red or
Gold top) clear plastic tube
Bartonella (Cat
Scratch)
SER.BA
8ml clotted blood (Red or
Gold top) clear plastic tube)
BK/JC PCR
SER.BKJC
Broncho-alveolar Lavage
or
 A pair of 'acute' and
'convalescent' sera:
normally collected 10 to
14 days apart, to
demonstrate, typically, a
4-fold rise in antibody
titre. For some pathogens
a longer interval (up to 4
weeks) may be required,
in order to demonstrate a
rise in titre
2 - 3 weeks
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Broncheo-alveolar Lavage or
4 ml LAVENDER capped,
clear plastic EDTA blood
2-5 days
26
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
8ml EDTA (purple top)
Bordetella pertussis
serology
SER.PE
Bordetella PCR
8ml clotted blood (Red or
Gold top) clear plastic tube)
Wirral patient Container
and comments
Turnaround
Times
tube
4 ml OCHRE capped, clear
plastic blood tube
Throat swab in viral transport media
5-7 days
2-5 days
Urgent 1-2
days
Brucella (Qfever
Antibodies)
SER.BR
Broncheo-alveolar
Lavage (Washings)
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Send washings in a sterile universal container
48-72hours
Campylobacter
serology
SER.CAM
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Candida Precipitins
SER.CA
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Catheter specimen
of urine (CSU)
Cervical swab
Chlamydia PCR
Transfer urine to a sterile universal container ( > 3ml )
48 Hours
For the investigation of
gonorrhoea use a Black
topped Microbiology swab
(Charcoal) and transport to
the laboratory immediately.
Urethral, rectal and throat
swabs may also be
collected and sent.
For the investigation of
gonorrhoea use a Blue
topped Microbiology swab
(Transtube) and transport to
the laboratory immediately.
Urethral, rectal and throat
swabs may also be
collected and sent.
For the investigation of
Chlamydia use a Chlamydia
swab and chlamydia
transport medium. Send a
swab in virus transport
medium for virology if
needed.
For the investigation of
Chlamydia use a Chlamydia
swab and chlamydia
transport medium. Send a
swab in virus transport
medium for virology if
needed.
For investigation of C. trachomatis infection, send a
chlamydia swab from the conjunctiva in virus transport
48 Hours
3-5 days
27
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
medium.
For detection in urine a clean catch urine is required,
optimally this should be collected in an APTIMA urine
collection tube. (Available from NHS Supply Chain code
HFL 1960).
Chlamydia (MIF)
Serology
SER.MIF
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
Detection of Clostridium difficile cytotoxin in faeces of
patients with antibiotic-associated diarrhoea, antibioticassociated colitis, or Pseudomembranous enterocolitis.
With the spatula provided transfer a plum-sized portion of
faeces, or equivalent volume of fluid, into a sterile universal
container.
Clostridium difficile
toxin
3-5 days
1 day
Only diarrhoeal stools Bristol Stool Chart 6 and 7 will be
tested
CMV IgM
SER.CMM
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
CMV IgG
SER.CMG
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
CMV PCR
SER.CMVP
Sputum, 8ML EDTA
(purple top), Placenta, >
3mls Urine or Liquor
Sputum, 4ml EDTA
(lavendar top), Placenta,
Urine or Liquor
2-5 days
Corneal scrape kits (containing a bijoux of broth and a
glass slide) Please indicate on glass slide which side
has been inoculated with a pencil in the frosted area.
Kits can be obtained from Microbiology during 9am –
4pm Monday to Friday.
Corneal scrapes
Coxsackie B virus
serology
SER.CB
Culture for bacterial
infections
8ml clotted blood (Red or
Gold top) clear plastic tube)
Pus is the ideal specimen
or a biopsy of the infected
tissue. Send in a sterile
universal container. If only
a small sample of tissue is
48 hours
Urgent gram
stain 1 hour
4 ml OCHRE capped, clear
plastic blood tube
3-5 days
Pus is the ideal specimen or
a biopsy of the infected
tissue. Send in a sterile
universal container. If only a
small sample of tissue is
48 hours
28
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Creutzfeldt-Jakob
Disease (CJD)
ONLY IN
CONSULTATION
WITH FIRSTLY
NATIONAL CJD
REFERENCE UNIT
(0131 537 2128)and
SECONDLY
MEDICAL
MICROBIOLOGY
CONSULTANT
Cryptococcus
antigen testing
Cerebral Spinal Fluid
(CSF)
Chester patient Container
and comments
Wirral patient Container
and comments
available, add a few drops
of sterile normal saline to
prevent drying. If swabs
are taken, Black topped
Microbiology swab
(Charcoal)
available, add a few drops of
sterile normal saline to
prevent drying. If swabs are
taken, Blue topped
Microbiology swab
(Transtube)
>1ml CSF, only accepted if <150 rbc. CSF sent to lab for
cell count. Lab will freeze at -80°C and send to Unit via
courier.
Turnaround
Times
1-2 weeks
National CJD Surveillance Unit, Western General
Hospital, Crewe Road.
Contact: Mary Andrews 0131 537 2128
8ml clotted blood (Red or
Gold top) clear plastic tube)
or
4 ml OCHRE capped, clear
plastic blood tube or
>1ml CSF in a sterile
universal container
>1ml CSF in a sterile
universal container
 Bacterial Meningitis >1ml CSF in a sterile universal
container
2-3 days
48 hours
 Viral Meningitis >1ml CSF in a sterile universal
container
3 days
 Sub Arachnoid Haemorrhage please send the first and
third specimen >1ml CSF in a sterile universal container
48 hours
 Mycobacterial Meningitis 6ml CSF in a sterile universal
container
7 -14 days
PCR Screen: >1ml CSF in a sterile universal container
3 days
Preliminary cell counts and Gram Stain results will be
telephoned to the sending location as soon as possible
29
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
after receipt of the specimen and released as
preliminary results for viewing on PCIS/CERNER or
MEDITECH
Delta Antigen
(Hepatitis D)
SER.DEL
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Dengue Virus
SER.DE
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Diphtheria
Antibodies
SER.DI
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-2 weeks
Ear swab
Send a swab in Black
topped Microbiology swab
(Charcoal)
Send a swab in Blue topped
Microbiology swab
(Transtube)
Early morning urine
for tuberculosis
First catch urine in the morning collect in a sterile universal
container, must send 3 consecutive samples
Entamoeba serology
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
48 hours
2-4 weeks
3 – 5 days
Detection of
antibodies to
Entamoeba
histolytica
Enterobius
vermicularis
(Threadworm)
Epstein-Barr virus
serology detection of
antibody to either
Epstein-Barr virus
capsid, antigen, or
early antigen.
Epstein Barr Virus
PCR
With a transwab, moistened with sterile saline, wipe firmly
around the anal margin and replace in the transport
container.
SER.EB
SER.EBP
Eye swab
1 day
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
CSF or 8ml EDTA (Purple
top)
CSF or 4ml EDTA (Lavender
top)
2-5 days
Send a swab in Black
topped Microbiology swab
Send a swab in Blue topped
Microbiology swab
48 hours
8ml clotted blood (Red or
Gold top) clear plastic tube)
30
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
(Charcoal).
(Transtube).
For investigation of
Chlamydia trachomatis
infection, send a chlamydia
swab from the conjunctiva
in virus transport medium
For investigation of
Chlamydia trachomatis
infection, send a chlamydia
swab from the conjunctiva in
virus transport medium.
Turnaround
Times
3-5 days
Enterovirus PCR
SER.ENT
CSF or 8ml EDTA (Purple
top)
CSF or 4ml EDTA (Lavender
top)
2-5 days
Farmers Lung
SER.FAR
8ml clotted blood (Red or
Gold top) clear plastic tube)
IMMUNOLOGY TEST
5-7 days
Faeces culture
With the spatula provided transfer a plum-sized portion of
faeces, or equivalent volume of fluid, into a sterile universal
container. Please indicate any foreign travel.
Functional
Antibodies to
meningococcal
vaccine
8ml clotted blood (Red or
Gold top) clear plastic tube)
48 hours
4 ml OCHRE capped, clear
plastic blood tube
2-3 weeks
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Serological tests for
specific antibodies
after vaccination.
Filariasis Antibiodies
SER.FI
8ml clotted blood (Red or
Gold top) clear plastic tube)
For skin, nail and hair clippings use black card, Dermapaks
or sterile universal.
Fungal Culture
Send a Blue topped Microbiology swab (Transtube) for the
investigation of Candida infections
Haemophilus
Influenza B (HIB)
Antibodies
SER. HIB
HIB PCR
8ml clotted blood (Red or
Gold top) clear plastic tube)
8ml EDTA (Purple top)
2 – 3 weeks
48hours
4 ml OCHRE capped, clear
plastic blood tube
2-3 weeks
4ml EDTA (Lavender top)
5 -7 days
31
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Hepatitis A IgG
Hepatitis B infection
Hepatitis B PCR
SER.HAM
SER.HAG
SER.BMARK
SER.HBVP
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
 Serology: detection of
IgM antibody in
jaundiced patients.
 Serology: detection of
IgM antibody in jaundiced
patients.
Positive serology indicates
recent or current infection
Positive serology indicates
recent or current infection
 Immune status
assessment: IgG serum
antibody, when
considering active or
passive immunisation.
 Immune status
assessment: IgG serum
antibody, when
considering active or
passive immunisation.
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
 Serology: detection of
surface antigen and
core IgM antibody in
jaundiced patient
 Serology: detection of
surface antigen and core
IgM antibody in jaundiced
patient
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
 PCR: To indicate viral
load and genotype
 PCR: To indicate viral
load and genotype
8ml EDTA (Purple top)
Hepatitis B e
Antibody/Antigen
Wirral patient Container
and comments
With the spatula provided transfer a plum-sized portion of
faeces, or equivalent volume of fluid, into a sterile universal
container. The test must be carried out within 72hours
of taking the specimen. PLEASE ENSURE THE
PATIENT DATES AND TIMES THE SAMPLE
Helicobacter Stool
Antigen
Hepatitis A IgM
Chester patient Container
and comments
SER.MARK
8ml clotted blood (Red or
Gold top) clear plastic tube)
Turnaround
Times
1-3 days
1-4 days
1-4 days
1-4 days
Urgent 2
hours
1-4 days
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Urgent 4
32
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
hours
Hepatitis B immunity
Hepatitis B Surface
Antigen
SER.SB
SER.SG
 Immune status:
assessment of surface
antibody, or to verify
seroconversion,
following vaccination.
 Immune status:
assessment of surface
antibody, or to verify
seroconversion, following
vaccination.
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
1-4 days
Urgent 2
hours
Hepatitis C screen
Hepatitis C
PCR/Genotype
SER.HC
SER.HCVG


Serology, detection of
viral antibody

8ml clotted blood (Red
or Gold top) clear
plastic tube)
4 ml OCHRE capped, clear
plastic blood tube.
PCR: To indicate viral
load and genotype

8ml EDTA (Purple top)
Hepatitis E Antibody
SER.HE
High vaginal swab
(HVS)
HIV 1 & 2 Antibody
and P24 Antigen
8ml clotted blood (Red or
Gold top) clear plastic tube)
Serology, detection of
viral antibody
PCR: To indicate viral
load and genotype
8ml clotted blood (Red or
Gold top) clear plastic tube)
1-4 days
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
4 ml OCHRE capped, clear
plastic blood tube.
Use a swab in Blue topped Microbiology swab (Transtube).
For PID, gonorrhoea and Chlamydia investigations send a
cervical or urethral swab and a urine in a sterile universal
for Chlamydia PCR.
SER.HIV
1-4 days
4 ml OCHRE capped, clear
plastic blood tube
3-5 days
48 hours
1-4 days
33
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
HIV Viral Load
SER.HIVQU
HIV Resistance
Testing
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
2-5 days
Characterising the
genotype of the HIV virus
and enhancing this by
matching to the database
of phenotypes for the HIV
gives a virtual phenotype of
the HIV virus. This leads to
an understanding of the
resistance mechanisms
that might be present.
Characterising the genotype
of the HIV virus and
enhancing this by matching
to the database of
phenotypes for the HIV gives
a virtual phenotype of the
HIV virus. This leads to an
understanding of the
resistance mechanisms that
might be present.
7-10 days
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
HSV 1 & 2 Antibody
SER.HS12
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
2-5 days
HSV 1 & 2 PCR
SER.HP
>1ml CSF
>1ml CSF
1-4 days
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
HTLV I/II Antibody
SER.HTLV
8ml clotted blood (Red or
Gold top) clear plastic tube)
4 ml OCHRE capped, clear
plastic blood tube
2-5 days
Human Herpes Virus
6 PCR
SER.HHV6
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
5-7 days
Human Herpes Virus
7 PCR
SER.HHV7
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
5-7 days
Human Herpes Virus
8 PCR
SER.HHV8
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
5-7 days
34
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Human Leukocyte
Antigen (HLA)
Hydatid, Malaria,
Schistosoma and
Amoeba antibody
tests
Influenza Virus A/B
Antigen
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
Detection of the HLAB*5701 antigen.
Detection of the HLA-B*5701
antigen.
7-10 days
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
MIC.INFNT
Nose/Throat swab in viral transport media
3 day
MIC.INFNT
Nose/Throat swab in viral transport media
1-3 days
Infection Control
Screen (MRSA
screen)
Blue top microbiology swab, nose and groin
48 hours
Infection Control
Screen (Resistant
Gram Negative
Organisms)
Blue top microbiology swab, nose and groin
48 hours
Intrauterine
contraceptive device
–IUCD
Send the device in a sterile universal container
48 hours
Culture for Actinomyces sp
10 days
Joint Fluids
>1ml in a sterile universal container
48 hours
Influenza Virus PCR
To include Swine Flu
H1 N1
If the specimen is urgent preliminary cell count and
gram stain will be telephoned to the sending location
as soon as possible after receipt of the specimen and
preliminary report released electronically.
Legionella Antigen
SER.LGA
>1ML Urine in a white capped sterile universal
1 day
35
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
Leptospira Antibody
SER.LE
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Lymes Disease
(Borrelia) Antibody
SER.LY
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Malaria Antibody
SER.MA
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Measles IgM
Antibody
SER.MEM
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
2-4 days
Measles IgG
Antibody
SER.MEG
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Urgent 2
hours
Measles PCR
SER.PCR
Please inform lab
about sample
despatch
Meningococcal &
Pneumococcal PCR
SER.MPCR
>1ml CSF
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
>1ml CSF
>1ml CSF
1-4 days
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
Urgent 1 day
If Urgent, please
inform lab about
sample despatch
Mouth swab
1-4 days
>1ml CSF
Send a swab in Blue topped Microbiology swab
(Transtube).
For virology send the swab in virus transport medium.
48 hours
1-4 days
Mumps IgM Antibody
SER.MUM
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Mumps IgG Antibody
SER.MUG
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5-7 days
Mumps PCR
SER. MUP
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
1-4 days
36
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
tube
For skin, nail and hair clippings use black card, Dermapaks
or sterile universal.
Mycology
Mycoplasma
Pneumoniae
Antibody
SER.MPM
Nasal swab
Norovirus PCR
Send a Blue topped Microbiology swab (Transtube) for the
investigation of Candida infections
48hours
8ml clotted blood (Red or
Gold top) clear plastic tube
3-5 days
4 ml OCHRE capped, clear
plastic blood tube
Send a swab in Blue topped Microbiology swab
(Transtube).
For virology, send a plastic shafted dacron swab in virus
transport medium.
MIC. FOUT
2-3 weeks
Only performed on liquid faeces Bristol stool chart 6 & 7 on
in patients in an outbreak situation after Consultation with
the Infection Control Team
48 hours
3-5 days
4 hours
With the spatula provided transfer a plum-sized portion of
faeces, or equivalent volume of fluid, into a sterile universal
container
Parvovirus IgM
SER.PM
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Parvovirus IgG
SER.PG
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
1-4 days
Parvovirus PCR
SER.PD
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
Use a pernasal swab and
transport immediately to
the laboratory
Use a pernasal swab and
transport immediately to the
laboratory
Pernasal swab
Pleural Fluid

Culture and
Sensitivity >1ml in
a sterile universal
container

Culture and
Sensitivity >1ml in a
sterile universal
container

Tuberculosis
culture >1ml in a
sterile universal

Tuberculosis culture
>1ml in a sterile
1-4 days
48hours
48hours
37
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
container
Pus
Wirral patient Container
and comments
Turnaround
Times
universal container
Transfer into a sterile universal container. Only use a
swab, Blue topped Microbiology swab (Transtube), if pus
cannot be obtained
48hours
Pneumococcal
Antibodies
(Quantitative)
SER.PNA
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
Pneumococcal
Antigen
SER.PN
Collect mid stream of urine
in a sterile universal
container (> 3ml).
Collect mid stream of urine in
a sterile universal container
(> 3ml).
Pneumocystis PCR
SER.PCP
Broncheo alveolar lavage
Broncheo alveolar lavage
3 -5 days
Sputum (ideally induced)
Sputum (ideally induced)
Urgent
24hours
8ml EDTA (Purple top)
8ml EDTA (Purple top)
Urgent Request
must be done in
conjunction with a
Consultant Medical
Microbiology
2-3 weeks
24hours
Polio Antibodies
SER.PO
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5 -7 days
Proviral HIV PCR
SER.HIVP
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic EDTA blood
tube
5 –7 days
Post vaccination assay
Post vaccination assay
2-3 weeks
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
Replaces the CFT
(Complement Fixation
Tests) tests.
Replaces the CFT
(Complement Fixation Tests)
tests.
Looking for the presence of
Influenza A and B,
Parainfluenza 1-4,
Metapneumovirus,
Respiratory Syncitial Virus,
Rhinovirus, Adenovirus and
Coronavirus Nasopharygeal
aspirates and Bronchio
alveolar lavage (send in a
sterile universal container)
Looking for the presence of
Influenza A and B,
Parainfluenza 1-4,
Metapneumovirus,
Respiratory Syncitial Virus,
Rhinovirus, Adenovirus and
Coronavirus in
Nasopharygeal aspirates and
Bronchio alveolar lavage
(send in a sterile universal
Rabies titres
Respiratory Screen
PCR
MIC.RPCR
Urgent screens
performed in
Outbreak situations
and by arrangement
with Consultant
Medical
Microbiologist
1-3 days
Urgent
24hours
38
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
or in patient’s sera (8ml
EDTA Purple top) Also
swab of nasal secretions or
throat swab, send plastic
shafted Dacron or rayon
swab in viral transport
media
container) or in patient’s
sera (4 ml LAVENDER
capped, clear plastic EDTA
blood tube) Also swab of
nasal secretions or throat
swab, send plastic shafted
Dacron or rayon swab in viral
transport media.
Supplies of swabs and
Viral Transport media can
be obtained from Pathology
Specimen Reception (In
outbreak situations
supplies may be placed in
other locations)
Respiratory Syncitial
Virus (RSV)
SER.RRRS
Naso-pharygeal Aspirate
Turnaround
Times
Supplies of swabs and Viral
Transport media can be
obtained from Pathology
Specimen Reception (In
outbreak situations supplies
may be placed in other
locations)
Naso-pharygeal Aspirate
24hours
Urgent 1hour
Rotavirus antigen
Rickettsia Antibodies
SER.RI
Rubella IgG
Detection of rotavirus in
faeces. (plum-sized portion
of faeces)
Detection of rotavirus in
faeces. (plum-sized portion
of faeces)
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5 –7 days
Immunity check: to assess
the immune status during
ante-natal care, or, earlier,
when pregnancy is
planned.
Immunity check: to assess
the immune status during
ante-natal care, or, earlier,
when pregnancy is planned.
2-5 days
8ml clotted blood (Red or
Gold top) clear plastic tube
Rubella IgM
24hours
4 ml OCHRE capped, clear
plastic blood tube
IgM antibody: to diagnose
acute infection in
symptomatic patients, or
recent exposure of close
contacts.
IgM antibody: to diagnose
acute infection in
symptomatic patients, or
recent exposure of close
contacts.
8ml clotted blood (Red or
4 ml OCHRE capped, clear
2-5 days
39
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Schistosoma
serology
Meditech
Code
SER.SCH
Chester patient Container
and comments
Wirral patient Container
and comments
Gold top) clear plastic tube
plastic blood tube
Detection of antibodies to
Schistosoma spp.
Detection of antibodies to
Schistosoma spp.
8ml clotted blood (Red or
Gold top) clear plastic tube
Turnaround
Times
5 – 7 days
4 ml OCHRE capped, clear
plastic blood tube
Screening swabs
and surface swabs
Send a swab in Blue topped Microbiology swab
(Transtube).
48 hours
Seminal fluid
Sterile universal container
48 hours
Sputum culture
Sputum from deep expectoration and not saliva is required.
Send specimen in a 30ml sputum container or universal.
48 hours
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5 – 7 days
A combination of nontreponemal and specific
treponemal antibody
screening tests for
Treponema pallidum.
A combination of nontreponemal and specific
treponemal antibody
screening tests for
Treponema pallidum.
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
Strongyloidies
Antibodies
Syphilis serology
Tetanus Antibodies
(Quantitative)
SER.ST
SER.STS
SER.TE
Throat swab
Tissues and biopsies
1-3 days
Urgent 1
hour
4 Weeks
Send a swab in Blue topped Microbiology swab
(Transtube).
48hours
For virology send the swab in virus transport medium.
7 days
Sterile universal container.
48hours
If biopsy is small add 0.5ml of sterile saline to prevent it
from drying out. Ensure there is NO formalin or other
preservative
(Depending on the nature of the tissue enrichment and
extended culture maybe required which will take up to 5
days)
40
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
TORCH Screen
SER.TOR
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
3 -5 days
Toxocara Antibodies
SER.TOX
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
5 – 7 days
Toxoplasma
antibody testing
SER.TO
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
2 - 4 days
Toxoplasma PCR
SER.TOP
Liquor or 8ml clotted blood
(Red or Gold top) clear
plastic tube
Liquor or 4 ml OCHRE
capped, clear plastic blood
tube
1-4 days
Tuberculosis
Best specimens are sputum, urine, pus or tissue. For
sputum and urine send 3 early morning specimens taken
on consecutive days
MB bact blood culture bottles available to send out to wards
for direct inoculation of blood or bone marrow for TB culture
4 – 6 weeks
4 – 6 weeks
Also note that heparinised blood is unsuitable for culture EDTA blood recommended
Urethral swab
For the investigation of gonorrhoea use a swab (Orange
topped Microbiology swab) transport to the laboratory
immediately. If there is likely to be a delay, keep at room
temperature.
For the investigation of Chlamydia use a Chlamydia swab
and viral transport medium
Urine
2 – 4 days
7 days
Collect mid stream of urine in a sterile universal container
(> 3ml).
Negative urine
Same day as
receipt
2 – 4 days
Positive urine
For Chlamydia trachomatis. Send a first-catch specimen.
Urinary Legionella
antigen & Urinary
Pneumococcal
antigen
Collect mid stream of urine in a sterile universal container
(> 3ml).
7 days
24hours
41
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
Wirral patient Container
and comments
Turnaround
Times
Varicella zoster IgG
Antibodies
SER.VG
Varicella zoster IgG. This
will indicate prior exposure
to, or possible ongoing
infection with, the virus.
Varicella zoster IgG. This
will indicate prior exposure
to, or possible ongoing
infection with, the virus.
2-4 days
Antibody negative pregnant
women with exposure
<
10 days can be offered
human Varicella zoster
immunoglobulin.
Antibody negative pregnant
women with exposure
<
10 days can be offered
human Varicella zoster
immunoglobulin.
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
3 – 5 days
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic blood tube
2-4 days
Varicella zoster IgM
Antibodies
SER.VM
Varicella zoster PCR
SER.VZP
Vesicles, ulcers and
genital lesions
Viral investigations
Send a swab in virus transport medium.
Urgent
Same day as
receipt
2-4 days
Viral PCR: of CSF, eye, nose, throat and other
appropriate swab. Swabs must be sent in viral
transport media, that can be obtained from Pathology
Specimen Reception
1 – 4 weeks
42
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
 Serology: antibody tests
for common pathogens
i.e. Adenovirus,
Coxsackie, Influenza,
Measles, or Mumps
viruses, and Mycoplasma
pneumoniae, selected
according to the
presentation of infection
and the clinical
information provided
Wirral patient Container
and comments

Serology: antibody tests
for common pathogens
i.e. Adenovirus,
Coxsackie, Influenza,
Measles, or Mumps
viruses, and
Mycoplasma
pneumoniae, selected
according to the
presentation of infection
and the clinical
information provided
8ml clotted blood (Red or
Gold top) clear plastic
tube
4 ml OCHRE capped, clear
plastic blood tube
Molecular techniques ie
PCR looking for viruses
require an EDTA blood
tube.
Molecular techniques ie
PCR looking for viruses
require an EDTA blood
tube
8ml EDTA (Purple top)
4 ml LAVENDER capped,
clear plastic blood tube
Turnaround
Times
2-4 days
2-4 days

Single 'acute', or 'convalescent', serum
Stored only until paired sample arrives then as below
(except for Chest Infections)
43
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Specimen /
investigation
Meditech
Code
Chester patient Container
and comments
 A pair of 'acute' and
'convalescent' sera:
normally collected 10 to
14 days apart, to
demonstrate, typically, a
4-fold rise in antibody
titre. For some pathogens
a longer interval (up to 4
weeks) may be required,
in order to demonstrate a
rise in titre
8ml clotted blood (Red or
Gold top) clear plastic
tube
Widal serology (No
longer available)
Replaced by Vi
ELISA. Salmonella
PCR
Wound and ulcer
swabs
Yersinia antibody
tests
SER.YE
Wirral patient Container
and comments
 A pair of 'acute' and
'convalescent' sera:
normally collected 10 to
14 days apart, to
demonstrate, typically, a
4-fold rise in antibody
titre. For some
pathogens a longer
interval (up to 4 weeks)
may be required, in
order to demonstrate a
rise in titre
Turnaround
Times
2 - 3 weeks
4 ml OCHRE capped, clear
plastic blood tube
Detection of antibodies to
Salmonella typhi and
Salmonella paratyphi. Past
typhoid vaccination, if not
disclosed at the time of the
test, may lead to a falsepositive result.
Detection of antibodies to
Salmonella typhi and
Salmonella paratyphi. Past
typhoid vaccination, if not
disclosed at the time of the
test, may lead to a falsepositive result.
8ml clotted blood (Red or
Gold top) clear plastic tube
4 ml OCHRE capped, clear
plastic blood tube
1 – 2 weeks
Send a swab in Blue topped Microbiology swab
(Transtube).
48hours
8ml clotted blood (Red or
Gold top) clear plastic tube
5-7 days
4 ml OCHRE capped, clear
plastic blood tube
Specimens should be transported and processed as soon as possible.
44
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
10. Key factors which affect the performance and or result of a
Microbiology Test
10.1
The technical competency, bias and experience of the staff performing the test.
10.2
The patient sample, how it is taken, stored and transported to the laboratory
10.3
The homogenicity of the patient sample i.e. Is there an even distribution of microorganisms within the sample?
10.4
Dilutions, how they are performed, what volume is used and how accurate is the
equipment used to perform the dilution.
10.5
Media and reagents, if they are not stored correctly, used in the correct way, expired and
are not sensitive and specific enough they will have a detrimental effect on the result.
10.6
Inoculation of media, volume of inoculum, media selection and spreading of inoculum
will affect the result.
10.7
Incubation conditions such as duration, temperature and humidity.
10.8
Reading and interpretation of results.
Under normal circumstances additional tests cannot be requested once the specimen has been
submitted to the laboratory. In special circumstances contact the Consultant Medical
Microbiologist.
45
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
11 Containers appropriate for the transport of specimens for
microbiological investigations
Specimens
Containers
Clotted blood, for serology.
Wirral: 4 ml OCHRE capped, clear plastic
blood tube.
Chester: 8ml clotted blood (Red or Gold top)
clear plastic tube) clear plastic tube
Blood for PCR (Viral DNA/RNA)
Wirral: 4 ml LAVENDER capped, clear plastic
EDTA blood tube
Chester: 8ml EDTA (Purple top)
Urine and other fluids.
20 ml universal bottle (white top).
Red top boric acid container (Chester urines)
For faeces, pus, tissues and other semisolid specimens.
60 ml wide-mouth container. (Wirral)
For the collection and transport of
specimens, when Chlamydia trachomatis
is suspected.
Use viral collection kit (2 female swabs and
viral /Chlamydia transport media)
For the aerobic collection of small
amounts of fluids, or exudates.
Wirral: Standard cotton wool-tipped rigid stem
swab (blue top) & transport medium
Blue 30 ml container with spoon (Chester)
Chester: Standard cotton wool-tipped rigid
stem swab (black top) & charcoal transport
medium
For sampling ear, nose or throat, or
urethral discharge.
Special cotton wool-tipped fine rigid wire swab
(orange top) & transport medium.
For sampling post-nasal space.
Special cotton wool-tipped fine flexible wire
swab (turquoise top).
For the anaerobic collection of pus, or
exudate.
Sterile universal container
For the collection and transport of swabs
for virus tissue culture.
Use viral collection kit (2 female swabs and
viral /Chlamydia transport media)
For the collection and transport of urine for
cytomegalovirus (CMV) tissue culture.
Early morning urine in sterile universal
container
46
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
12
REFERENCE RANGES
SPECIMEN
URINE
REFERENCE RANGE
COMMENT
White Blood cells <28 x106/L
Red Blood Cells <17x106/L
CSF
White Blood cells <30 x106/L
Neonates/Newborns
Red Blood Cells <1 x106/L
Anti Streptolysin-O antibody,
Serum
White Blood cells <5 x106/L
Adults
Red Blood Cells <1 x106/L
NB. Any increase in red blood
cells may indicate a traumatic
tap.
0 - 200 IU/Ml
Adult
0-100IU/Ml
Child under 4
Hepatitis B Immunity
An antibody level below
10mIU/ml is classified as a
non-response to vaccine.
Responders with anti-HBs
levels of 10 to 100mIU/ml
should receive one
additional dose of vaccine at
that time.
Responders with anti-HBs
levels greater than or equal to
100mIU/ml do not require any
further primary doses.
47
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
13
Routine Referral Laboratories
Small Animal Hospital
Crown Street
Liverpool
L7 7EX
Dept of Medical Microbiology
Southmead Health Services NHS Trust
Southmead Hospital
BRISTOL
Health Protection Agency (HPA)
Laboratory of HealthCare Associated Infection
Specialist and Reference Microbiology Division
61 Colindale Avenue
London
NW9 5HT
Haemophilus Reference Unit
Respiratory & Systemic Infection Lab
Health Protection Agency
61 Colindale Avenu
London
NW9 5HT
Manchester Central Laboratory Service
3rd Floor, Clinical Science Building
Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
Dept of Immunology
City Hospital
Dudley Road,
Birmingham
B18 7QH
48
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Microbiology Laboratory
Hope Hospital
Eccles Old Road
Salford,
Manchester
M6 8HD
School of Tropical Medicine
Pembroke Place
Liverpool
L3 5QA
Meningococcal Reference Laboratory
Public Health Laboratory
Withington Hospital
M20 8LR
Dr Ray Borrow
Manchester Medical Microbiology Partnership
PO Box 209
Clinical Sciences Building
Manchester Royal Infirmary
M13 9WZ
Vet Lab Agencies
Woodham Lane
New Haw
Addlestone
Surrey
KT15 3NB
Dr Dinah Pillay
Heartland Hospital
Boardesley Green
East Birmingham
B95 5T
49
Directorate of Laboratory Medicine, Microbiology Department.
Author P. Ashcroft
Ref. No. MNSOP30
Reviewed by:
Last reviewed
Approved by:
G.Mihr
Next review date: February 2014
Appendix 1 – Location of Medical Microbiology Department