laboratory application form

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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
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