User Manual - Scotland's Health on the Web
Contents
1. Turnaround times for cultures are dependent on receipt of a pure culture containing sufficient mycobacteria for analysis The time interval between receipt of a culture and the issue of the final identification and first line sensitivity report varies greatly from 1 12 weeks depending on factors such as the nature of the culture medium used by the sending laboratory paucity of organisms in the culture the species of Mycobacteria and the presence or absence of contamination Turnaround times to result entry availability for 95 of samples Test Turnaround time in working days 5d week laboratory service Clinical specimen examination culture isolation and identification where the isolate is subsequently shown to be MTB complex 26d from receipt of specimens mean 13d Automated liquid and conventional solid culture on all samples being processed for mycobacterial culture Set up working day from receipt of specimens Provisional identification of MTB complex by nucleic acid amplification test 4d from receipt of a positive cultures mean 2d Sensitivity testing of MTB complex 22d of isolate receipt isolation mean 13d MIRU VNTR typing 38d from receipt of isolate mean 17d MTB complex final identification 25d from receipt of isolate mean 12d Identification of NTM 14d from receipt of isolate mean 5d The costs for NHS users indicated on page 11 will be re2. mycobacteria and screening for drug resistance on acid fast bacillus AFB smear positive respiratory samples Further advice is also available as detailed on page 13 amp 14 The laboratory is based within the Royal Infirmary of Edinburgh Little France Crescent Edinburgh EH16 4SA It is fully integrated with the combined laboratories of the University Hospitals Division of NHS Lothian SMRL is funded through an agreement between National Service Scotland and NHS Lothian University Hospitals Division Some services have been developed which are available at a charge to the user This manual covers three levels of service 1 National Reference services funded by National Services Scotland NSS Services paid for by charging the users per test 3 Services provided by NHS Lothian to the local and other Boards by Service Level Agreement These Boards are currently NHS Borders NHS Fife NHS Dumfries and Galloway NHS Highland NHS Forth Valley and NHS Tayside Telephone and Email Enquiries TB Laboratory Tel 0131 242 6022 23 TB Office Tel 0131 242 6016 mailto LOTHIAN SMRL phs net Fax machines are not considered a safe method of transmitting sensitive information therefore fax machines across NHS Lothian have or are in the process of being removed Current fax number 0131 242 6008 Core Hours The core laboratory hours are 9am to Spm Monday to Friday but not weekends Christmas and New Year holidays At other times Lothian l
3. pre 1 5ml optimum 3 5ml from SMRL Citrated blood also acceptable alternative at present incubate inoculated bottles Bone marrow Use Myco F lytic blood culture bottles available from SMRL citrated blood or disposable plastic sterile universal container The latter if AFB smear required Do not refrigerate or pre incubate inoculated bottles Skin preparation is key to reducing contamination CSF Disposable plastic sterile universal container Recommended minimum volume of 6mls This may have greater sensitivity than PCR Stools Disposable plastic sterile universal container These are rarely informative and minimum 1g with spoon are heavily contaminated PM specimens Disposable plastic sterile universal container or larger screw capped sterile container if appropriate DO NOT USE FORMOL SALINE OR FORMALIN Swabs Dry or stuart s transport media Pus is always preferred if available Swab microscopy is not routinely performed Cultures Egg medium slopes or aliquots of liquid At least Smls required if grown medium in liquid medium FFPE tissue for PCR Please send 3 x 10u sections in a screw capped eppendorf type tube taken using a new blade to prevent contamination Authority for Issue Mike Smith Page 9 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Tests Available Turn Around Times and Costs
4. 31 242 6079 Mike Smith BMS Team Manager 0131 242 6009 Laboratory 0131 242 6022 EH16 4SA mailto LOTHIAN SMRL nhs net Patient s Surname Home Address oi ese ess secsscsone ssessssre cosueeeee cecccccceusescceceee ceusuaeee eeseesaea suaeeeeess Date of Birth Divccsseee ee Country Of Origin oo eles ceeeeeee ceeeeeeee ceeeaeeees Race or Ethnic Group sesssese ceeceesee ceeeeeees ceeeeeenee aeeeaeees Hospital or Clinic No wees cesses ceeeeesee ceeeseeees Laboratory Reference No n s escceeee cesceeee ceeeeeeeee eeeeeees CHUNUMDET osote aere duende aedcvbeay uevpaney E EEA EE ayaa saero tags exces N EE E EEEE ley Patients Hospital secsicnsirsuisiiiscnniiviarsrssiiorencerivirnes Patient s Consultant Sending Laboratory eriein siine e E E E AE E aE E a O a Date of specimen or received date lei fiai AFB Microscopy of specimen POS NEG Sample Type Positive Culture U or Primary Specimen E Specimen typ lsolation Sitecns snoin icersicavia caniaii eoi acd a ar E a a ia aaiae aa eai aeaa es pearkes Antimicrobials at the time of sampling seesssssssesssssssse sesrsssee seessrese ceeeaeeeee sersetsse ceeeeneee saeeeeaee caeeeneaee seseresee Comments From Local Laboratory sssss 0 00 sorses cence restei dtrian ce eneee resres ceeeeee ahotan giint seaeeeaee Yes If NTM identified are ATS criterion met for infection No The form below for SMRL use only AP Film of Speci
5. 42 781 www oxfordimmunotec com Authority for Issue Mike Smith Page 8 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Sample Types and Containers for Mycobacteria Investigation Specimen type Containers and transport Comments Sputum 3 to preferably 5ml Disposable plastic sterile universal container Decontaminated and neutralised samples may lose viability during transit Induced sputum Disposable plastic sterile universal container Bronchoalveolar lavage BAL Bronchial Washings 3 10ml Disposable plastic sterile universal container Pleural fluids amp aspirates up to 25ml Disposable plastic sterile universal container Biopsy material including Disposable plastic sterile universal container DO NOT USE FORMOL pleural biopsies add a few drops of preservative free 0 9 SALINE OR FORMALIN sterile saline to keep sample moist Tissues including heart Disposable plastic sterile universal container DO NOT USE valves add a few drops of preservative free 0 9 FORMOL SALINE sterile saline to keep sample moist OR FORMALIN Early Morning Urine Sterile 500ml bottles filled up to 2 3 full Send EMU bottles available on request three samples on successive days from the stores department Astley Ainsley Hospital Edinburgh for Lothian users Blood Myco F lytic blood culture bottles available Do not refrigerate or
6. Document No SMRL 65 Version No _Review date T Lothian LOTHIAN UNIVERSITY HOSPITALS DIVISION DEPARTMENT OF LABORATORY MEDICINE Scottish Mycobacteria Reference Laboratory amp NHS Lothian Mycobacteria Laboratory User Manual Authors Dr I F Laurenson amp Mike Smith Scottish Microbiology Reference Laboratories Edinburgh http www edinburghlabmed co uk Specialities reflab Pages default aspx NB THIS IS AN ELECTRONIC DOCUMENT WHICH IS UNCONTROLLED WHEN PRINTED Authority for Issue Mike Smith Page 1 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 August 2013 CPA Accredited INDEX Scottish Mycobacteria Reference Laboratory sccisasce tande vi pnesstegeaes te cepeenthecbintiel awa oapmienie cds 3 Telephone a d Email Enguirie Ss cazrcneeatssonccesgasateoayrsaganaza sna ia ene aan ere a n een eta i Tesan onite t 3 Core HOUTS mirana a a a a a a e e a 3 ELOTE E A E E aavidlude cde teed bein eaeiuoti sid uasea cates etude vanes 4 Packing and Transport of Infectious Substances ic secs ccsssce e cveceeevetccenastvovapecetadsnesevbcevetewiesevees 5 BC VEILS OL Service eea anae aa a ed a e eta Bla in ath st bb lore cect cue 6 Samples for Mycobacterial Investigations 0 0 0 0 eee eeseeseeceseceseecsseeeseeseseesseecsaeesseessseeeseeesseeeaes 6 Sample Types and Containers for Mycobacteria Investigation cc eeeeeeeeceseeeeeeeeneeeseeeeseeeees 9 Tests Available Turn Around T
7. M s quarterly at present Further comment analysis is available on discussion with a senior member of SMRL staff and a letter may be issued Paraffin sections Paraffin embedded tissues can be examined for the molecular detection of MTBC Results are normally reported within 5 working days Cumulative reports Cumulative results on a patient with positive results can be produced on request Please contact senior BMS or medical staff at SMRL At present only Authorised Final reports on each test are available on SCI store Interim results are not available Authority for Issue Mike Smith Page 13 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Technical Scientific and Health and Safety Advice The technical and scientific staff at the SMRL are happy to provide advice on all laboratory aspects of microscopy and isolation of Mycobacteria and on the safe running and design of containment level 3 laboratories Please contact Mr Mike Smith BMS Team Manager Mrs Pauline Claxton or Mrs Christine Doig BMS Section Managers for technical help and advice Clinical Epidemiological and Infection Control Advice The primary source of medical advice for the diagnosis management and public health investigation of TB lies with the consultants in the relevant specialties in the local health board The consultant microbiologists attached to the SMRL are happy to complement this primary advice where appropriate P
8. aboratory users can discuss urgent AFB microscopy via the Consultant Specialist Registrar on call for clinical bacteriology contact Royal Infirmary of Edinburgh switchboard Tel 0131 536 1000 There is no out of hours AFB screening or Reference Laboratory service For urgent enquiries out of hours the on call Consultant Microbiologist may be contacted through the RIE switchboard Tel 0131 536 1000 in the first instance Authority for Issue Mike Smith Page 3 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Contact List Name and Designation Telephone Numbers and e mail Address Mrs Shona Hannan Reference Laboratory Administrator Dr Ian Laurenson Director Dr Ewan Olson Deputy Director Mr Mike Smith BMS Team Manager Mrs Pauline Claxton BMS Section Manager Mrs Christine Doig BMS Section Manager BMS Specialists Mr Gary Davidson Mr Lukman Elabor Mrs Fiona Mathewson Ms Sandra Houston Mr Neil McMinn MTO Mrs Jane Greig Advanced BSW Dr Louise Seagar Clinical Scientist Tel 0131 242 6016 Shona Hannan luht scot nhs uk Tel 0131 242 6079 Tan Laurenson luht scot nhs uk Tel 0131 242 6072 Ewan Olson luht scot nhs uk Tel 0131 242 6009 Michael Smith luht scot nhs uk Tel 0131 242 6009 Pauline Claxton luht scot nhs uk Tel 0131 242 6009 Christine Doig luht scot nhs uk Tel 0131 242 6022 6023 Tel 0131 242 6009 Louise Seagar luht scot nhs uk The serv
9. b all the liquid in the vial and to protect it from breakage 4 Seal this package twice in plastic bags For posting by Hays DX courier for all cultures preferred for specimens 1 Place the sealed specimen bag into a screw cap container from a DX box and put with it the corresponding request forms 2 Carefully place the destination address label provided on the green tracking label on the package taking care not to cover any of the peel off barcodes or tracking numbers Also leave some space next to the lines for receiver s Hays DX number and Exchange code Place some clear selotape over the label to ensure it is not easily removed or damaged by rain again avoiding covering any peel off labels 3 Fill in the Hays DX number and Exchange code of the destination 4 Peel off one of the two matching tracking numbers at the bottom of the Tracked Specimen label and stick it in the provided Hays DX logbook and fill in the receiver s details and date of dispatch 5 At the top of the Hays DX label fill in the sender s name sender s Hays DX number sender s exchange code and the name and contact number for the sender This information is written on a separate card at the front of the Hays DX logbook 6 Place the provided blue security seal sticker over the package closure and dispatch For ae by First Class Post Samples Only Place the wrapped sample inside the inner container of the packaging and tighten the lid Place the inner co
10. between requesting service and NHS Lothian e Processing of routine samples from patients for mycobacteria investigation Samples for Mycobacterial Investigations 1 Microscopy All samples except blood swabs and urine are routinely examined for direct AFB microscopy provided there is sufficient specimen 2 Culture Our current practice is to inoculate all specimens into liquid and solid media 3 Drug susceptibility testing Susceptibilities are routinely performed on the first isolate from each patient and then only repeated at 3 month intervals 4 Molecular tests Smear positive respiratory samples are tested by rapid molecular tests if sufficient quantity is received Authority for Issue Mike Smith Page 6 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Users should inform us in advance of cultures or specimens that are being sent by post or courier A staff member of the SMRL should be contacted by phone see contact list above or by e mail mailto LOTHIAN SMRL nhs net We will issue a receipt or report within one working day from receipt of cultures or samples A completed SMRL request form see page 18 must accompany every culture or specimen Wherever possible please time the posting of samples and cultures to minimise the possibility of these lying unattended over weekends and holidays All requests must provide the following Minimum Data Set information Forms 1 Patient Identifier Numb
11. er CHI for Scottish patients 2 Postcode of patient where available 3 Sender s Laboratory Number 4 Surname 5 Forename 6 Date of Birth 7 Gender 8 Location of Sender 9 Specimen type or if culture isolate specimen type from which the culture was isolated 10 Any relevant clinical information If results need to be telephoned please supply contact details 11 If possible patient s hospital and consultant Sample Minimum data are also required on the sample container 1 Surname 2 Forename 3 Date of Birth 4 Sample date and time 5 Sample type and site 6 Location of patient 7 Sending Laboratory number if applicable Vials On culture vials patient name and the sender s Laboratory Number are required as a minimum Specimens should be correctly collected and delivered as quickly as possible to the laboratory Although TB bacilli can survive in sputum for one week the probability of successfully culturing the bacilli decreases with time and is especially critical for paucibacillary specimens If specimens cannot be transported to the laboratory within one hour it is recommended to store them at 4 C This does not apply to whole blood or bone marrow specimens in Myco F Lytic bottles which should not to be refrigerated or incubated prior to sending Authority for Issue Mike Smith Page 7 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 5 Interferon Gamma Release Assay IGRA for detection o
12. f latent TB infection Testing is currently performed in house for NHS Lothian patients by the Specialist Virology Centre using the Quantiferon TB Gold In Tube Assay Other Health Boards may use this facility via a Service Level Agreement with NHS Lothian Potential users should contact Linda Mulhern Tel 0131 242 6017 mailto linda mulhern luht scot nhs uk Operational Science Manager Microbiology Quantiferon tubes and Sarstedt Universal Bloodculture Adaptors are available from catalogue on PECOS system If a Safety Multifly is used the line must be primed with an empty Sarstedt tube first to ensure the correct volume 1ml of blood is delivered into each tube Tubes should be inoculated in the order of Nil TB Antigen and Mitogen It is important to gently shake the tubes ten times to ensure the entire inner surface of each tube is coated Samples should be dispatched to the laboratory as soon as possible but must reach the laboratory within 16 hours of collection Do not refrigerate See the Guidelines for NHS Lothian users of Microbiological and Virological Specialist laboratory details for full details Laboratories outwith NHS Lothian may incubate tubes overnight which may then be sent according to SLA to the NHS Lothian Specialist Serology Virology centre The T spot assay is another IGRA which is available from Oxford Immunotec 115D Milton Park Abingdon Oxfordshire OX14 4RZ Tel 44 0 1235 442 780 Fax 44 0 1235 4
13. ibility Broth As required 3 14 days For rapidly growing testing of Rapid microdilution incubation mycobacteria Growers Rapid molecular Real Time Weekly Tuesday Test is only validated First smear ve respiratory detection of MTBC PCR pm Wednesday pm for respiratory samples samples are free to NHS Scotland users otherwise the charge is 132 60 Rapid rifampicin Genotype Weekly Wednesday and isoniazid MTBDR plus pm Thursday am resistance detection Molecular Weekly All new TB patients genotyping of M isolates are typed tuberculosis Currently 24 locus MIRU VNTR Newer technologies such as next generation sequencing may become available shortly Paraffin sections for Real Time Weekly Tuesday 79 56 for NHS users molecular detection PCR pm Wednesday pm on of MTBC request Authority for Issue Mike Smith Page 11 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Molecular Detection of Mycobacteria in Specimens Note on rapid molecular tests False negatives and false positives can and rarely do occur We currently use an in house real time PCR for the direct detection of MTBC in specimens and we continue to use the Genotype MTBDRplus kit Hain Lifescience for the direct detection of rifampicin and isoniazid resistance in samples From time to time alternative methods such as the Xpert MTB RIF Cepheid may be used Direct detection of MTBC from formali
14. ice is managed overall by NHS Lothian If we are unable to deal with an issue and you wish to discuss a matter with NHS Lothian Management then contact Linda Mulhern Tel 0131 242 6017 mailto linda mulhern luht scot nhs uk Operational Science Manager Microbiology NHS Lothian Mr Ian King Tel 0131 242 7051 mailto Jan King luht scot nhs uk Healthcare Science Manager Cell Sciences NHS Lothian Authority for Issue Mike Smith Page 4 of 18 Document No SMRL 65 Version No 16 0 Review date ______ _31 03 2017 Packing and Transport of Infectious Substances Postal Address DX Address Scottish Mycobacteria Reference Laboratory Exchange Edinburgh 96 EH Department of Laboratory Medicine DX Number DX6231201 Royal Infirmary of Edinburgh 51 Little France Crescent Old Dalkeith Road Edinburgh EH16 4SA NB Infectious substances may only be transported in packaging which meets the U N Class 6 2 specifications and the 602 packing requirements All Cultures must be sent by Hays DX Courier or equivalent NOT by post They must conform with the Transport of Dangerous Goods Act Cultures for routine processing should not usually be sent in batches Packaging Mycobacteria Cultures or Samples 1 Remove any water of condensation from the solid culture vial s taking normal safety precautions for handling cultures 2 Seal the cap with parafilm 3 Wrap individual vials in sufficient absorbent material to absor
15. if you have such a secure laboratory address to automatically email each time there is an updated report Please contact Mike Smith or Shona Hannan in the first instance if you wish to use this means of reporting Authority for Issue Mike Smith Page 12 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Written report formats Initial Report on specimens Microscopy results Acid Fast Bacilli NOT seen Culture report to follow Microscopy results Few Acid Fast Bacilli seen Culture report to follow Microscopy results Microscopy findings equivocal Advise repeat sample Equivocal result means 1 2 acid fast bacilli seen per 300 fields This is NOT a definite positive result and artifacts could cause this level of acid fast material in a specimen Culture report to follow Initial Reports on Cultures received Confirmation as a Mycobacterium and provisional species identification is normally reported in writing within 4 working days of receipt of culture This is achieved by AFB microscopy to confirm the presence of mycobacteria and rapid molecular methods for identification of cultures Final Report on Cultures received Confirmed species identification and first line sensitivity results may take from as little as one week to up to 12 weeks Molecular Typing M tuberculosis genotyping results are reported as they are done and comparisons of the genotypes of strains suspected to be clustered are reported to CPH
16. imes and Costs 0 c ccccccsscsssssesssescsssssssssessssssssssssssesssssseees 10 Molecular Detection of Mycobacteria in Specimens 0 0 0 eeeeeeseeeseeeseeeseeeseeeeaeeeseeeeseesseeeeaees 12 RG POTS Ol Res ltS hioen aane a E E E E T E eens 12 Technical Scientific and Health and Safety Advice snnneseneseeesseesseeesseresseesssesseeessersseressee 14 Clinical Epidemiological and Infection Control Advice ssesseeeseseeseesesereerersrrsresrersrssresssses 14 Fraime anid Education iiasi nera e sho deads eu a E i snap see us gos eiaeag hewmen a E AS 14 Researchiand AVUI a reese a AARNA RRE a a eee 15 Quality ASSupanee a in n E EE EEEE E E EERE EEE ede ETEEN E 15 Antimicrobial ASSY eaei ee a a E E R E E E A E 16 Leprosy DiaghOSiSen nesese ea de debe EE A E a EENET ETES ET 17 SCOTTISH MYCOBACTERIA REFERENCE LABORATORY FORM eee 18 Authority for Issue Mike Smith Page 2 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Scottish Mycobacteria Reference Laboratory The Scottish Mycobacteria Reference Laboratory SMRL is the Scottish Reference Laboratory for Mycobacteriology particularly for the identification drug susceptibility testing and strain typing of Mycobacterium tuberculosis complex MTBC and non tuberculous mycobacteria NTM The laboratory receives approximately 1 000 mycobacterial cultures per year mainly from Scottish NHS laboratories The service is also funded to perform rapid detection of
17. le data searches to more formal grant applications dependent on ethical approval where relevant and availability of resources Contact details Please contact Dr Ian Laurenson Director Dr Ewan Olson Deputy Director or Dr Louise Seagar Clinical Scientist for discussions regarding research audit collaboration Quality Assurance The SMRL is committed to high quality laboratory analysis The laboratory participates in the UK National External Quality Assurance NEQAS scheme for Mycobacteria microscopy culture and molecular typing as well as Quality Control for Molecular Diagnostics QCMD for molecular detection in specimens The laboratory also participates in the WHO Drug Proficiency Testing Scheme an external QA scheme for sensitivity testing against first line anti tuberculous drugs We also carry out Internal Quality Assurance IQA SMRL is fully CPA accredited The SMRL Annual Report and User Manual are available on the HPS website http www hps scot nhs uk reflab RefLabDetail aspx id 16 Authority for Issue Mike Smith Page 15 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Antimicrobial Assays The following information is for assays on first line TB therapy drugs Information on other anti mycobacterial drugs can be found at http www assayfinder com accessed March 2015 Isoniazid Rifampicin Pyrazinamide and Ethambutol Dr Alan Hutchings Toxicology Laboratory The Academic Centre Lland
18. lease contact Dr Ian Laurenson Director or Dr Ewan Olson Deputy Director for advice on issues such as microbiological diagnostic tests antibiotic susceptibility tests strain typing for contact tracing and infection control Training and Education Audit Study Day Every two years the laboratory hosts an Audit Study day to allow SMRL staff to meet and discuss various issues with reference laboratory users public health consultants chest physicians and Health Protection Scotland HPS representatives The last meeting was held in March 2015 Attachments and visits Each year SMRL provides training attachments for staff from other laboratories including Biomedical Scientists Clinical Scientists and Trainee Doctors SMRL also provides support for undergraduate science and medical students MSc students and projects for Trainee Doctors Visits and lectures by SMRL staff to other institutions Staff at SMRL provide teaching and advice at local and national level on invitation particularly in the areas of diagnosis patient management and molecular epidemiology Contact details To discuss short visits to SMRL for training purposes please contact Mr Mike Smith BMS Team Manager in the first instance Authority for Issue Mike Smith Page 14 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Research and Audit Staff are willing to collaborate in relevant audit and research activities This may take the form of simp
19. men Neg Glycerol Date Pyruvate Date MGIT MB Date Sub to Date sub d BA Contaminated ZN Result E B D Sens required esis V ERE coho Growth Pigment For SEQ Eord Y N Culture Identified as Mike Smith Page 18 of 18 Authority for Issue
20. n fixed paraffin embedded FFPE tissue is available by arrangement Results have to be interpreted with caution Accuracy is partly dependant on avoiding laboratory cross contamination not only in microbiology and the PCR suite but also in histopathology Results to date suggest approximately 72 of MTB complex will be detected by this method as compared with concurrent mycobacterial culture FFPE specimens are not suitable for culture Reporting of Results Policy and procedures for telephoned results Previously unknown AFB smear positive or discrepant samples are telephoned as soon as possible usually within 1 working day of receipt New positive MTB complex cultures obtained from smear negative samples are also phoned as soon as possible after their presence is confirmed in the culture All NTM are reported and or e mailed New M abscessus from NHS Lothian locations are telephoned in addition The following examples will also be telephoned results of direct rapid molecular tests on specimens if findings are unexpected clinically important identification or drug susceptibility test results e g primary resistance to first line drugs acquired new resistance unexpected mycobacterial species new positive cultures from smear negative specimen blood Emailing of reports to secure nhs net accounts is set up already for some user laboratories In some instances no other written report is sent out We can set this up
21. ntainer into the outer cardboard box Close the box and secure with tape Stick address label on the top of the box Stick From label with senders address on the bottom of the box Post by First Class Post or courier such as DX for samples Authority for Issue Mike Smith Page 5 of 18 JANA WN Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Levels of Service 1 National Services Scotland funded Remit SMRL receives cultures of presumed mycobacteria from all NHS laboratories in Scotland These cultures are tested to determine e Presence of mycobacteria Full species identification Susceptibility to standard anti mycobacterial drugs Susceptibility to second line anti mycobacterial drugs where appropriate Rapid liquid culture of smear positive respiratory samples Molecular typing and comparison of M tuberculosis complex strains Use of molecular tests on smear positive respiratory samples to rapidly identify the presence of mycobacteria and screen for drug resistance in M tuberculosis complex 2 Services available by charging users e Rapid liquid culture of samples from normally sterile sites e g CSF bone marrow tissue samples aspirates and bronchoalveolar lavage samples e Molecular tests on smear negative samples and smear positive non respiratory samples e Culture of smear negative samples e PCR for molecular detection of MTB complex in fixed paraffin sections 3 Services available by contract
22. ough Hospital Penarth CF64 2XX United Kingdom 029 2071 6893 029 2035 0142 HutchingsAD cf ac uk Accredited The Therapeutics amp Toxicology Centre is a WDA Centre of Expertise http www ctlabs co uk Rifampicin Prof Andrew Lovering Department of Medical Microbiology Southmead Hospital Wesibury on Trym Bristol BS10 5NB United Kingdom 0117 323 5698 0117 323 8332 andrew lovering nbt nhs uk Accredited http www bcare nbt nhs uk Authority for Issue Mike Smith Page 16 of 18 Document No SMRL 65 Version No 6 0 Review date 31 03 2017 Leprosy Diagnosis The SMRL does not undertake investigations for the diagnosis for leprosy Clinicians should refer all suspected or confirmed cases to one of the national leprosy centres where the case can be reviewed by a Consultant Advisor in Leprosy Contact in the first instance Professor Diana Lockwood Consultant Advisor in Leprosy Hospital for Tropical Diseases Mortimer Market Centre Capper Street London WCIE 6JB Tel 0203 456 7890 Ext 75972 Fax 0203 447 9761 mailto diana lockwood shtm ac uk Authority for Issue Mike Smith Page 17 of 18 Document No SMRL 41 Version No 6 0 Review date 31 03 2017 SCOTTISH MYCOBACTERIA REFERENCE LABORATORY FORM Microbiology Laboratory Royal Infirmary of Edinburgh Little France 51 Little France Crescent Edinburgh Telephone numbers Enquiries 0131 242 6016 Dr Ian F Laurenson 01
23. viewed annually They may vary without notice Costs for private tests are available on request Authority for Issue Mike Smith Page 10 of 18 Document No SMRL 65 Version No Review date 6 0 31 03 2017 Test Method Test frequency and turn Comments Costs around time Microscopy Auramine Within working day if All specimens Costs indicated below against for acid fast bacilli Phenol receipted prior to mid day examined by AP Primary culture include AFB detection staining Mon Fri microscopy are primary specimen microscopy cultured for mycobacteria Primary Culture Solid Daily Usually available 2 6 Results from 27 33 for external NHS users modified LJ weeks after receipt of contaminated 26 66 for SLA pyruvate egg sample Cultures are specimens may be slope and reported negative at 8 weeks delayed rapid liquid if appropriate but kept for 12 Free for NHS Lothian users culture weeks in total MGIT Species Molecular Twice weekly Tues Fri 1 Additional molecular identification of identification 7 days or phenotypic methods cultures methods may be required for some strains and this may cause delay Drug susceptibility Liquid culture Set up daily or weekly Tests for 2 and 3 testing of slow broth depending on methodology line TB drugs set up on growing microdilution request or when there mycobacteria for MOTT is resistance to any first line drug Drug suscept
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