Basingstoke and north hampshire hospital pathology user handbook

Common causes of spurious results

Please ensure that you follow instructions when collecting and storing samples. Inappropriate sample collection, storage and transport can interfere with a number of results. Some examples are given in the table below:

Bacteriology

Problem	Common causes	Effect
Delay in transport/ in­correct post collection storage	Samples not refrigerated	Overgrowth of growing bacteria
Incorrect container	Blue trans swab for virus/chlamydia	Overgrowth of bacteria
	Virus/chlamydia swab for bacteria	Bacteria killed by container ingredients
Unsterile container	Household jars medicine containers camera film pots	Contamination or bacteria killed by previous contents. These containers are also unsafe due to potential breakages/leakage in transport
Leaking samples	Non laboratory approved container	Health hazard to all surgery, transport and pathology staff
Lack of appropriate clinical details	No reference to foreign travel. No reference to pregnancy. No reference to antibiotic allergies. No reference to past/current/intended antibiotics	Appropriate tests not performed. In complete/misleading results and comments

Serology

Problem	Common causes	Effect
Haemolysis	Expelling blood through needle into the tube	Inaccuracy in many tests.
Incorrect container		Unable to perform tests
Lipaemic		Inaccuracy in many tests

MICROBIOLOGY ROUTINE REFERENCE LABORATORIES

Cambridge PHL Box 26 Addenbrookes Hospital Hills Road Cambridge C42 2QW CPA Ref. 1071	HPA Virus Reference Division Central Public Health Laboratory 61 Colindale Avenue London NW9 5HT CPA Ref. 1883	Laboratory of Enteric Pathogens Central Public Health Laboratory 61 Colindale Avenue London NW9 5HT CPA Ref. 1683
HPA Microbiology Lab, Level B Southampton General Hospital Southampton SO16 6YD CPA Ref. 2838	Manchester Medical Microbiology Partnership, PO Box 209 Manchester Royal Infirmary Manchester M13 9WZ CPA Ref. 0635	Birmingham Heartlands Hospital Bordesley Green East Birmingham B9 5ST CPA Ref. 0818
Leptospira Reference Unit Public Health Laboratory County Hospital Hereford HR1 2ER CPA Ref. 1180	Centre for applied Microbiology & Research, Porton Down Salisbury Wiltshire SP4 0JG CPA Ref. 1612	Department of Clinical Microbiology Queen Alexandra Hospital Cosham Portsmouth CPA Ref. 0989
Singleton Hospital Sgeti Swansea SA2 8QA CPA Ref. 2913	Dept. of Microbiology Leeds General Infirmary Great George Street Leeds LS1 3EX CPA Ref: 0061

PHONED RESULTS SHEET: please photocopy and use

Patient’s name ................................. DOB ............ NHS/Hospital No: .......................

Consultant/GP…………….. Ward ………………

HAEMATOLOGY	BIOCHEMISTRY	MICROBIOLOGY
Haemoglobin g/d	Sodium mmol/L	Specimen:
White cell count 10^9/lL	Potassium mmol/L	MICROSCOPY:
Platelet count x10^9/L	Urea mmol/L	White cells
ESR mm/hr	Creatinine umol/L	Red cells
Neutrophils %10^9/L	Alk Phos IU/L	Epithelial cells
Lymphocytes %10^9/L	Bilirubin umol/L	Casts
Monocytes %10^9/L	ALT (SGPT) IU/L	Organisms:
Eosinophils %10^9/L	Calcium mmol/L
Glandular Fever	Phosphate mmol/L	CULTURE:
MCV fl	Magnesium mmol/L
Haematocrit 10^9/L	CRP mg/L
Reticulocytes 10^9/L	Glucose mmol/L
Sickle test	Iron umol/L
COAGULATION:	Uric Acid mmol/L	ANTIBIOTIC Sensitivity:
PT secs	Cholesterol mmol/L	Penicillin
PTT secs	HDL Chol mmol/L	Erythromycin
Fibrinogen g/l	Triglyceride mmol/L	Flucloxacillin
D-Dimer	CK IU/L	Amoxycillin
Warfarin dose	Amylase IU/L	Augmentin
Next appointment	LDH IU/L	Cefalexin
TRANSFUSION:	GGT IU/L	Nitrofurantoin
Group	Tot Protein g/L	Trimethoprim
Rhesus	Albumin g/L
DCT	Globulin g/L	Other tests:
Kleihauer	TSH mu/L
Other tests	Troponin	Gentamicin ug/l

Date................... Time...................... Signed/Received by …………………………….

How to get to Basingstoke & North Hampshire Hospital

The hospital is located on the A340, Aldermaston Road in Basingstoke: follow the Hospital signs from the Ring Road.

By car: There are a number of parking areas available: there is a drop off point and a number of disabled parking spaces available outside the main entrance. Please allow extra time on arrival, as parking is sometimes difficult. Public car parks are now barrier controlled and a pay on exit scheme has been introduced.

0 to 1 hour - £1.00

1 hour 1 min to 2 hours - £2.00

2 hours 1 min to 4 hours - £3.00

4 hours 1 min to 6 hours - £4.00

6 hours 1 min to 24 hours - £5.00 maximum fee

There is no charge for disabled parking in the bays marked for this purpose.  Please ensure you display your Blue Badge.

Cars that ‘enter’ between 19:50 and 05:59 inclusive stay free (regardless of time of exit).This is to ensure that night shift workers and visitors can park safely next to the buildings.

The Foundation Trust is serviced by regular buses from Basingstoke town centre:

Bus numbers 32 and 32a from Newbury calls at Newbury Bus Station; Chandos Road; Wendan Road; Sandleford Rise; Newbury Tesco; Newtown,A339,A34 Junct.; Greenham Park East; Headley The Harrow Public House; Kingsclere Square;          

Wolverton Pond; Rooksdown cross roads and Basingstoke and North Hampshire NHS Foundation Trust.

Bus number 45 from Sherfield calls at Bramley Station; Post Office; Bramley Church; The Vyne; Sherborne St. John and Basingstoke and North Hampshire Foundation Trust. 

See www.stagecoachbus.com for up to date timetables.

Click here for Basingstoke bus routes

Need any help getting to hospital?

Neighbourcare: www.neighbourcare.org.uk

Basingstoke Community Transport: 01256 320501 or www.bct.me.uk

www.hants.gov.uk/passengertransport

Traveline is a service which allows you to plan your journey by giving you all the times and routes you need to get to the hospital without using your car.

You can access the information by going to www.traveline.info

Alternatively, if you prefer to speak to someone, call 0871 200 22 33.  Calls cost 10p per minute (plus network extra if calling from a mobile).

Site Map

TEST INDEX

BACTERIOLOGY
TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Adenovirus and Rotavirus	Liquid stool in 60ml sterile container	Diarrhoea in children under 3 years	2
Aspirates and fluids from normally sterile sites	25ml sterile universal container (white top).		2
Blood cultures	Venous blood is collected aseptically into blood culture bottles. Take before antimicrobials are given if possible. Clean site and bungs of bottle(s) with alcohol wipe and allow to dry before collection. Adult: approx. 5-10ml blood into each bottle. Child: approx. 0.5- 4.0ml blood into one paediatric bottle.	Septicaemia, pneumonia, endocarditis, meningitis, pyrexia.	Preliminary report: 2 Full report 6
Bronchial washings	60ml sterile container or 25ml sterile universal container (white top).		2
Broncho-alveolar lavage	60ml sterile container or 25ml sterile universal container (white top).		2
Cerebrospinal fluid (CSF)	For cell count, gram staining and culture send 0.5 -1mL CSF in each of four 25ml sterile universal containers (white top). If meningitis is suspected contact the laboratory and send the specimens immediately. Send specimens 2 and 3 to micro and 1 and 4 to biochemistry for protein (including SAH examination if appropriate).	Meningitis, subarachnoid haemorrhage (SAH), encephalitis.	Microscopy: 0.5 Culture: 2
Cervical swab	Endocervical swabs are required for gonococcal or chlamydial investigations. For gonorrhoea use a bacterial swab (blue top). Urethral, rectal and throat swabs may also be collected.	Pelvic inflammatory disease, vaginal discharge, suspected STD.	2

TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Chlamydia	Males: >20ml urine sample in a 25ml sterile universal container. The patient should not have passed urine in the hour prior to collection or Urethral swab in Chlamydia transport medium. Females: urethral/endocervical swabs in chlamydia transport medium or urine in a 25ml sterile universal container.	Pelvic inflammatory disease, urethritis.	5
Clostridium difficile toxin	Liquid stool in 60ml sterile container Testing performed on in-patient samples and community patients over 60 years of age ONLY.	Diarrhoea	1
Contact lens and lens fluid	25ml sterile universal container (white top) or lens case.		14
Ear swab	A bacterial swab (blue top).	Ear infection, otitis media, otitis externa.	2
Eye swab	Routine culture: a bacterial swab (blue top).	Conjunctivitis	2
Faeces	For bacteriology, parasitology and virology: with the wooden spatula provided transfer a grape sized portion or equivalent volume of fluid into a 60ml sterile container. Clostridium difficile toxin detection is only performed on semi solid and liquid samples. Follow up testing is rarely required.	Diarrhoea, gastro-enteritis and outbreaks.	3
Hair	Refer to mycology.
High vaginal swab	Collect a swab (blue top) for candida, trichomonas vaginalis, bacterial vaginosis and bacterial pathogens. For PID, chlamydia and gonorrhoea investigations see cervical swab.	Vaginal discharge, SROM.	2

TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Intrauterine device (IUCD)	Send in a 60ml sterile container.		2
IV line tips	Aseptically place the terminal 5-10cm of the tip into a 25ml sterile universal container.	Line infection, septicaemia.	2
Joint fluid	For microscopy and culture. Send in a 25ml sterile universal container (white top). Crystals performed by Histopathology.	Arthritis, infection, gout.	2
Legionella antigen	25ml sterile universal container.	Atypical pneumonia	1
Legionella culture (sputum)	Sputum from deep expectoration and not saliva is required. Saliva will not be processed. Collect into a 60ml sterile container.	Atypical pneumonia.	5
Mouth swab	A bacterial swab (blue top).	Oral candidiasis.	2
MRSA screening swabs	A bacterial swab (blue top). For hospital patients refer to the Hospital Infection Control Policy. For community patients, screening is only normally required for known positive patients prior to elective surgery.		2
Mycology	For skin, hair and nail clippings use black card or paper. Skin: Scrape skin with a blunt scalpel from the active edge of the lesion. Nail: Cut small pieces of the nail using clippers. Hair: Forceps may be needed to remove body hairs. Infected hair stumps are easily removed by scraping with a scalpel. A bacterial swab (blue top).is used for candida infections.	Dermatophyte infections.	Microsocopy: 2 Culture: 21
Nail	Refer to mycology.

TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Nasal swab	A bacterial swab (blue top).	Specific organism screen, eg MRSA, Staph aureus.	2
Nasopharyngeal aspirate	Traps containing a specimen should be sealed using a loop of tubing alternatively use a 25ml sterile universal.	Respiratory tract infection	2
Pleural fluid	25ml sterile universal container (white top).		2
Pneumococcal antigen (urine).	25ml sterile universal container (white top). By prior arrangement with the laboratory.	Atypical pneumonia.	0.5
Pus	Transfer into a sterile universal container. Only use a bacterial swab in charcoal transport medium when pus cannot be obtained.	Infected site	2 (culture for anaerobes 5 days)
RSV	Nasopharyngeal aspirate into a 60ml sterile container.		0.5
Saliva testing (for Measles, Mumps and Rubella)	Please contact the Microbiology laboratory on 01256 313309/13	Rash	Referred specimen 21 Days
Schistosoma parasites (Urine)	Recommended method: Collect the last few drops of urine from each micturition over a 24 hour period in a plain 25ml sterile universal container. Acceptable alternative: Collect a random specimen ideally between 12.00 and 15.00 hours after light exercise (e.g. 20 rapid knee bends) to maximise the release of eggs.	(Bilharzia) Travel to endemic area	1
Sellotape slide	Refer to Threadworm.
Seminal fluid for culture	25ml sterile universal container (white top).	Blood in seminal fluid	2

TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Sputum	Sputum samples are best collected in the morning. It is important that the specimens submitted for examination are true sputum and not saliva, or contaminated with food. Sputum from deep expectoration is required. Saliva will not be processed. Collect into a 60ml sterile container.	Chest infection, pneumonia.	2
Threadworm	Collect the sample in the morning before the patient has washed. Press the sellotape onto the peri-anal skin firmly. Remove and stick the sellotape flat onto a clean microscope slide (sticky side down) keeping as flat as possible . Place this in a slide box.	Anal irritation/itching.	1
Throat swab	For bacterial investigation send a bacterial swab (blue top). For virology investigations send a viral swab (green top)	Pharyngitis	2 Virology referred sample 21 Days
Tissue and biopsies	Sterile container. If the sample is small add sterile saline to prevent it drying out.	Infected site	7
Tuberculosis	The best samples are early morning sputum, pus or tissue in a 60ml sterile container. Only collect urine when renal tuberculosis is suspected; collect the complete early morning specimen in 250ml containers on three consecutive days.	Night sweats, low grade fever. Renal TB.	Microscopy: 1 Culture: up to 40 days
Urethral swab	For the investigation of gonorrhoea use a bacterial (blue top). and transport to the laboratory immediately. For the investigation of Chlamydia use a Chlamydia swab in Chlamydia transport medium.		2

TEST	SAMPLE & COLLECTION INSTRUCTIONS	COMMON INDICATIONS	TURNAROUND (working days)
Urine	MSU, CSU, supra pubic aspirate, ileal conduit specimens are all collected into red top 20ml sterile universal containers containing the preservative boric acid (red top). To collect an MSU allow the first part of the urine to be voided. Collect the mid-part of the sample then void the remainder of the specimen. CSU’s are only appropriate when clinical indication of fever, rigors or supra pubic pain are present. CSU’s will NOT be processed without these clinical indications given on the request card.	UTI, haematuria, fever, inflammatory response.	1
Viral	Viral swab (green top) HSV PCR tests are now used. Each test is specific for each virus. Please state clinical details and/or virus suspected.		In-house 5 days Referred specimens 21 days
Wound and ulcer swabs	A bacterial swab (blue top). Collect as much material from the infected site as possible avoiding contamination from surrounding areas. Ulcer swabs are only appropriate when signs of severe clinical infections are present.	Infection at local site.	2 (culture for anaerobes 5 days)