Application form to join the UK Clinical Mycology Network Laboratory/centre name Contact person* Date Dr/Mrs/Ms/Mr/other Last name: First name: Contact address Postcode: Telephone Email *Contact person will also be the proposed representative to join the UKCMN steering group This laboratory / centre operates at level (see p2&3 for descriptions & tick which applies): A. Local microbiology laboratory B. Specialist microbiology centre C. Regional mycology centre D. HPA mycology reference laboratory Above Local level, the UKCMN will grant provisional status to laboratories / centres which do not meet the criteria but plan to implement any missing requirements within a year of applying. Please use pages 2&3 to indicate where this applies. Please state whether you are joining in collaboration with another laboratory / centre. If so provide name of laboratory/centre and contact name or attach forms for joint application. 1 Application form to join the UK Clinical Mycology Network Please indicate whether the following criteria are met (M), planned within the year (P) or will not be met (X) at your laboratory / centre. For any planned criteria please give further details on current status and implementation dates in the additional comments box. A. Local microbiology laboratories This represents the minimum acceptable provision of mycology services by clinical microbiology laboratories, and should include the following: 1. Accreditation by a nationally-recognised quality scheme e.g. CPA or ISO 9000 2. Member of UKNEQAS scheme for mycology 3. Primary fungal cultures from blood, deep and superficial infections 4. Identification of Candida spp. to “germ tube” level 5. Identification of dermatophytes to species level 6. Microscopy on respiratory and other fluids for fungal elements and Pneumocystis jirovecii 7. The ability to provide clinical advice on common fungal problems (e.g. candiduria) Note: No mycology-dedicated staffing levels are specified 9. Any additional comments (please continue on separate sheet if necessary) M/P/X B. Specialist microbiology centres This level of service should be available in all teaching hospitals and specialist cancer, haematology, transplant and HIV centres 1. All services as for local microbiology laboratories (above) 2. Cryptococcal antigen test 3. Aspergillus antigen test 4. A minimum of one Healthcare Scientist dedicated to mycology 5. Any additional comments (please continue on separate sheet if necessary) M/P/X 2 Application form to join the UK Clinical Mycology Network C. Regional mycology centres This level of service confers representation on the Clinical Mycology Network Steering Committee (except for provisional applicants) 1. All services as for specialist microbiology laboratories (above) 2. Fungal serology 3. Identification of unusual fungi (excluding containment level 3 pathogens) 4. Antifungal susceptibility testing 5. Antifungal therapeutic drug monitoring 6. Active training programme in mycology 7. Active programme of mycological research 8. Provision of clinical advice on all forms of fungal infection by locally-based staff, either medically qualified or appropriately trained Healthcare Scientist(s) 9. Provision of approved molecular diagnostics 10. A minimum of three Healthcare Scientists dedicated to mycology 11. Any additional comments (please continue on separate sheet if necessary) M/P/X D. Mycology Reference Laboratory This represents the highest level of mycology provision in the UK. 1. All services as for regional microbiology laboratories (above) 2. Identification of all fungi by culture-based methods 3. Identification of rare fungi sequence-based methods 4. Provision of validated molecular diagnostic services 5. Provision of typing service for outbreak investigation 6. Provision of a focus for national standards and training in laboratory mycology 7. Collection of national datasets 8. Maintenance of the National Collection of Pathogenic Fungi M/P/X Go to page 4 to add names of laboratory/centre personnel to join the email discussion group. 3 Application form to join the UK Clinical Mycology Network Please give names and email addresses of laboratory/centre personnel who wish to join the UKCMN email group. List here or add sheet of paper if necessary. Title First name Last name Email address Please return to: Chris.Linton@bris.ac.uk UKCMN secretariat, HPA Mycology Reference Laboratory, Microbiology services, HPA South West Regional Laboratory, Myrtle Road, Kingsdown, Bristol. BS2 8EL 4