Microbiology and Virology Clinical Advice

Need Microbiology/Virology Clinical Advice?

The senior medical and scientific staff of the Microbiology and Virology laboratories provide expert advice on clinical, scientific and technical issues to users of the service.

The clinical service is consultant-led and available on a 24-hour basis to hospital clinicians and GPs.

MICROBIOLOGY

Please tell us who the patient is: Patient’s name, PID, location. (Note all consultations and advice given is documented in our laboratory system).

Please have the patient’s notes and observation chart with you.

  • The clinical diagnosis and the possible focus of infection
  • The precise symptoms and signs suggestive of infection
  • Previous microbiology and other relevant results (temperature, WCC, CRP, renal and liver function)
  • Community or hospital onset infection
  • The patient’s observations
  • Relevant clinical history e.g. travel, immunocompromised
  • Recent imaging and procedures/surgery
  • Indwelling devices: urinary catheter, IV lines, stents/prosthesis
  • Current/previous antibiotics: dose and duration
  • Antibiotic allergies and allergy type (rash, lip swelling)

Please note our advice is based on the information provided.

  • For simple queries the Trust anti-microbial guidelines should be reviewed – you can find these on the Trust Intranet or by downloading them to your mobile phone via the MicroGuide App.
  • Always ensure the case has been discussed with the Consultant caring for the patient before contacting microbiology.
  • Always review Clinical Infection in Concerto before contacting microbiology. If the patient has not been discussed with Microbiology before there will not be any Clinical Infection entries in Concerto.

Please note:

All positive results from sterile sites (including blood cultures) are phoned out by the laboratory when positive.

Heartlands, Good Hope and Solihull Hospitals during normal working hours Mon – Fri ( 9 am to 5 pm)

For non-urgent queries please download and fill in the referral form (which can be found on the Trust Intranet under A for Antibiotic guidelines) and email it to This email address is being protected from spambots. You need JavaScript enabled to view it..

Please note referrals made without completing the form will not be accepted.

  •  We aim to respond to all e-mail referrals on the same day. Referrals made after 3 pm may be dealt with on the next working week day.
  •  Please DO NOT use the e-mail referral system out of hours including weekends unless your query is not urgent and can wait to be dealt with on the next working week day.

For ALL URGENT queries during normal working hours Monday to Friday (9 am to 5 pm) please see below:

  •  For Heartlands and Solihull please contact the duty Microbiologist on extension 43240 or alternatively on their mobiles through switchboard.
  •  For Good Hope please dial # 6276 or 07917 648 323.
  •  Queries deemed non-urgent nor immediate will be re-directed to the above email referral system

Heartlands, Good Hope and Solihull Hospitals Out of Hours

OUT OF HOURS for ALL sites:

Please contact the duty Microbiologist through switchboard. Please be aware they may not have access to results so carefully review Concerto for alerts etc.

Heartlands, Good Hope and Solihull Hospitals – Infectious Diseases advice

To contact the on call Infectious Diseases clinician bleep 2728 -  ID SpR (9 am to 8 pm) weekdays and (8 am to 6 pm) weekends and Bank holidays. After these hours please contact the Infectious diseases consultant via switchboard.

VIROLOGY

Who to call: During working hours, please contact the Virology registrar on Bleep #2821. A consultant Virologist is available via switchboard on a 24 hour basis.

Please be aware that out-of-hours that the Virologist may not have access to results, so carefully review iCare for alerts etc.

When you call: Please tell us who you are: name, team and bleep number.

Please tell us who the patient is: name, PID, location. (Note all consultations and advice given is documented in our laboratory system).

Please have the patient’s notes and observation chart with you.

  • The precise symptoms and signs suggestive of infection
  • Relevant clinical history eg. travel, immunocompromise
  • Recent imaging

The virology department also offers the following services:

Specialist Advice: The consultant virologists provide specialist advice for patients throughout the West Midlands, including clinical interpretation of laboratory results and risk assessments for exposure to blood-borne viruses. The laboratory also serves as a national reference centre for HIV resistance testing, as well as providing resistance testing for Hepatitis B and CMV. The laboratory is one of two designated laboratories for the testing of Hepatitis B in healthcare workers undergoing exposure-prone procedures, as per DOH guidelines.

Outbreak support:Support to the PHE Health Protection Teams, CsCDC and Local Authority Environmental Health Departments is provided at two levels. Consultant staff provide expert clinical advice on specific infections and guidance on appropriate laboratory investigations. They also act as the local and regional microbiology co-ordinator. The laboratory provides support for testing of specimens collected in the course of outbreak investigations. Staff are co-opted onto Outbreak Control Teams and attend outbreak review meetings. Senior staff are also expected to give advice and support to the work of other Agencies.

Immunoglobulins and Vaccines: As part of the PHE, the Microbiology laboratory supplies and provides advice on the use of specific immune globulins for:

  • Varicella Zoster
  • Hepatitis B
  • Rabies

Normal immunoglobulin is also available for use within published guidelines.

In cases of possible exposure to rabies, both specific immune globulin and vaccine may be supplied for post-exposure prophylaxis. For these services, please contact the duty clinical virologist via Heart of England NHS Foundation Trust switchboard (0121 424 2000).

 

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Protocol for Antibiotic Assays

Samples For all antibiotic assays, 5-10mls blood into red-topped tube (no anticoagulant) DO NOT sample from the line through which the antibiotic has been given.

 

Antibiotic Sampling Time First Sample Expected Levels Usual interval to re-assay

 

VANCOMYCIN

 

Pre-dose only (i.e. within 15 mins before dose)

 

Around 2nd – 4th dose

10 – 20mg/L

3 days

 

GENTAMICIN / TOBRAMYCIN (b.d or t.d.s regime)

Pre-dose (within 15 mins before dose)

and

Post-dose (1hr after dose)

Around 2nd – 4th dose

Pre less than 2mg/L

Post 5 – 10 mg/L

3 days

GENTAMICIN / TOBRAMYCIN (once – daily regime) Post-dose only taken between 6 and 14 hours after dose.

N.B. Times of dosing and sampling must be given on request form.

1st to 3rd dose

Interpretation by Microbiologist

3 days

Important Notes

  1. After taking pre-dose levels, give the prescribed dose as normal – DO NOT wait for the results of the assay.
  2. “Random” levels should seldom be needed and should only be taken by prior arrangement with the Duty Microbiologist.
  3. For patients with stable renal function, whose results are within the expected range, assays do not need to be performed more than twice a week. Where renal function is unstable or poor, assays should be discussed with the Duty Microbiologist.
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Vancomycin Service

Intravenous vancomycin treatment requires regular monitoring of pre-dose (trough) levels. The trough level should be 5-15 mg/l.

Results will be made available on the Results reporting system as soon as they are processed n the laboratory. It is the responsibility of the doctor requesting the assay to check the result on the Results Reporting system. However, significantly abnormal results will be telephoned to the clinician by the Duty Microbiologist

INTRAVENOUS VANCOMYCIN MONITORING CHART

Vancocycin Flow Chart

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Antibiotic Assays

Determination of serum antibiotic concentration is usually necessary in two circumstances:-

  • Where drugs of known, dose-related toxicity are used.

and

  • b) In order to monitor levels when the drug used has a narrow therapeutic range.

For aminoglycosides (gentamicin and tobramycin), efficiency is related to peak concentrations achieved, while for glycopeptides such as vancomycin, efficiency is related to the time over which therapeutic levels are maintained.

Information on performing antimicrobial assays is given below, but Medical Microbiologists are available, at all times, to discuss assays and the interpretation of results.

Antibiotic dosage in renal failure can be obtained from the appropriate Intranet site.

Antibiotic assays are performed twice a day and are processed in batches, a morning run and an afternoon run. Any bloods sent for antibiotic assays after 2pm will be processed the next day.

Assays are NOT generally available out of hours, but blood may be taken and stored on the ward to be submitted the following morning.

All of these antibiotics are stable at room temperature or in the refrigerator.

 

Protocol for taking samples for Antibiotic Assays

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A General Guide to Requesting and Sampling

This is a draft protocol being piloted in the Trust & will be subject to review.

GUIDELINES FOR TAKING ROUTINE SPECIMENS

(* Does not include MRSA specimens) *Routine specimens (see specific protocols for Urology, Gynaecology, ITU, HDU etc)

URINE

  • Do not take urine samples just because urine is cloudy, smelly or offensive. Send urine samples if the patient has signs or symptoms of UTI (e.g. pyrexia). 
  • Obtain specimen before commencement of antibiotics, as results are difficult to interpret once antibiotics have been commenced.
  • Do not take routine specimens at catheter changes, do not send catheter tips.
  • Use boric acid red top urine sample tubes and fill to line.

FAECES

  • Send specimen on patients with diarrhoea where an infective cause is suspected. Do not send a specimen if one has been sent in the last seven days as this will not be processed.

CLOSTRIDIUM DIFFICILE

  • Do not send repeat specimens to see if negative as decision not to isolate is made on the cessation of diarrhoea not microbiology results.

SWABS

  • Only take specimens from postoperative wounds if there is a purulent discharge i.e. the wound is discharging pus.

PRESSURE SORES

  • Only take a swab if there is inflammation in the surrounding area and a purulent discharge. N.B An offensive smell alone is NOT AN indication to take a swab.

SPUTUM

  • Sputum specimens should only be sent on patients with a diagnosis of pneumonia and only if they are productive and they have not yet commenced on antibiotics. If already on antibiotics, this MUST be recorded on the request form. Samples from COPD patients need to be specifically requested by medics. TB specimens should be requested by medics and 3 early morning specimens are required.

If sample is urgent please telephone the laboratory so that it is expected and can be processed as quickly as possible.

N.B Tips, Catheters and drains are not useful specimens as they are often contaminated or colonised and do not provide useful information.

HPA Sampling Procedure
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HTA licence number is 12366

Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

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