HSL Microbiology Request procedures
All routine specimens from the main hospital sites and Mortimer Market should be sent to the Rapid Response Laboratory (RRL) specimen reception area (SRA) located in 60 Whitfield Street.
Royal Free London
All routine specimens should be sent to the Central Pathology Reception Area 2 (SRA2) on the 1st floor of the main Royal Free Hospital Building or to the Barnet site Rapid Response laboratory. Where possible please order test request(s) using Cerner. If unable to use the system, send a blue microbiology request form with the test request(s) and clinical details.
All routine specimens from the main hospital sites should be sent to the Rapid Response Laboratory (RRL) specimen reception area located on the North Middlesex Site.
All other users
All other users of services must ensure that samples are sent to the hospital site with which you have pre- agreed prices and/or a service level agreement in pace. Samples must be received with clear requests with clinical details, and clearly labelled specimens.
Requesting additional tests (add on requests)
After sample receipt: this is dependent on the retention time of the sample in the laboratory. The retention time varies for different types of clinical specimens; this information is available from microbiology on request. Please discuss the additional requests with the microbiology doctors or the laboratory.
Specimen acceptance/rejection criteria
Pre-examination sample suitability and integrity will influence the final test result that is reported by the laboratory and can also impact on the safety of laboratory staff. As a result the laboratory will reject the specimen and not proceed with analysis of samples if it meets one or more of the following criteria:
- Specimens or request forms are received without the minimum essential identification criteria.
- Grossly leaking or broken specimen containers.
- Inappropriate specimens for the test requested.
- Tissue specimens received in formalin, formal saline or any other fixative is not suitable for investigation by microbiological culture.
All samples received for Creutzfeldt-Jacob Disease (CJD) testing are sent to the National Creutzfeldt-Jacob Disease surveillance unit (CJDSU) in Edinburgh. The clinical team considering sending the test must discuss the case with CJDSU (Dr Alison Green or Dr Mary Andrews on 0131 537 3075) in advance. If testing is agreed, the CJDSU will organise a courier to pick up the specimen from the laboratory and they will liaise with the laboratory in advance to arrange a suitable time for collection. The sample is stored at –20°C in the CL3 laboratory until collection.
Laboratory opening hours and urgent processing
The department operates a 24/7 shift system. There are always Microbiology staff available on site at the Halo Building, including at nights, weekends and public holidays. There is a reduced number of staff working after 8pm on weekdays, and at weekends and bank holidays.
Microbiology sample reception on all sites is also open 24/7 on all days for receipt of specimens and to arrange transport of urgent specimens. Each site has regular set transport times to transport specimens to the Halo building. In addition, the SRAs will arrange urgent courier collection to expedite transfer for urgent specimens to the Halo for urgent processing.
A 24-hour service is provided for urgent requests. Requests submitted for urgent analysis must be agreed with the laboratory in advance and may require discussion with the microbiology clinical doctors if the urgent request is not part of laboratory urgent repertoire.
Urgent specimens should be marked clearly and, ideally, should be hand delivered to the SRA and handed directly to a member of SRA or RRL staff.
If hand-delivery is not possible, the SRA staff should be telephoned to alert them that a specimen requiring urgent attention is on its way If the SRA is not alerted to an urgent specimen, it is unlikely to be detected among the routine work arriving at the SRA.
The SRA will arrange an urgent courier to transport the specimen to the Halo building for urgent processing. The Laboratory will endeavour to report out all urgent tests within the published turnaround times.
Pre-inoculated agar plates for corneal scrapings must be transported immediately to the laboratory for incubation.
For the diagnosis of amoebic dysentery, fresh (still warm) ‘hot stool’ or rectal scrape is required. Any aspirated pus from abscesses for parasite investigations must also be submitted fresh and warm and treated as urgent. The specimen needs to be examined without delay; the sample collected must therefore be transported and rushed to the laboratory immediately. Please contact the laboratory or RRL in advance, to inform them that the sample is on its way.
Out of hours (8pm-8am)
A limited number of Microbiology tests are available out of hours in order to prioritize tests where a rapid result can influence the treatment of a patient:
- Cerebrospinal (CSF), peritoneal, ascitic or other sterile fluid for microscopy and culture set up
- Corneal scrapings pre-inoculated plates and slides for microscopy and incubation
- Urgent auramine stain for TB (AAFB microscopy)
- Paediatric urine microscopy
- Stool samples for Clostridium difficile testing in consultation with the on-call medical microbiologist
- Other specimens in consultation with the on-call medical microbiologist
- Processing within High Level Isolation Unit in the event of patient admission (via specific on-call rota)