Departments

Microbiology

About EPA Microbiology

The Microbiology Department, based at the Norfolk and Norwich University Hospital (NNUH) is part of the Eastern Pathology Alliance (EPA), a managed Pathology network involving laboratories at NNUH, the James Paget University Hospitals (JPUH) NHS Foundation Trust and the Queen Elizabeth Hospital (QEH) Kings Lynn. NNUH is the entity with legal responsibility for the EPA. All Microbiology for the EPA is performed at the NNUH laboratory.

The department is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189:2012. The defined schedule of tests for which the laboratory is accredited can be found by clicking on the link below.

To view accreditation schedule no.10296 please visit https://www.ukas.com/

The department has rapid access to national reference laboratory facilities through the UK Health Security Agency.

It also provides epidemiological data for the Communicable Disease Surveillance Centre in Colindale, and investigates outbreaks of infectious disease in support of the Consultant(s) in Communicable Disease Control at the Health Protection Unit.

The EPA Microbiology Department participates in National External Quality Assessment Schemes for bacteriology (including Mycobacteria), virology, serology, mycology and parasitology.

These department pages provide information about how users can access our services, who to contact for advice, which tests we perform, sample requirements, normal ranges and turnaround times. This information is accurate at time of issue and is reviewed and updated regularly to incorporate new developments.

For patients using this website please note that any information provided should not be used for self-diagnosis and should you have any concerns about your health please consult your GP.

If you find any errors within this information or would like to make any comments and/or suggestions for improvement, please contact Diane Murley, EPA Quality Manager on 01603 286900 or email diane.murley@nnuh.nhs.uk

Test Samples

Supply of specimen containers

ONLY THOSE CONTAINERS APPROVED BY EPA ARE TO BE USED

See EMC-QUP-011 App 1 Microbiology Department Specimen Container Guide (Leaflets section) for a visual guide of the approved containers to be used.

For NNUH, specimen containers for wards are supplied via the top up teams with the exception of faeces pots, MRSA broths, virus transport medium (VTM) and Microbiology request forms which are available from Pathology stores.

For JPUH, specimen containers for the wards are ordered via procurement.

For QEH specimen containers for the wards are supplied via top-up teams.

The following containers are supplied to GPs for microbiological investigations. Send orders by email to EPAGPConsumables@nnuh.nhs.uk. For more information please see our Supplies page.

  • Faeces pots.
  • Microbiology request forms (for locations that do not have access to WebICE only).
  • Pernasal swab kits for whooping cough
  • Collection kits for Chlamydia trachomatis (see Section 20.4.3 Chlamydia, Gonorrhoea and Trichomonas Investigation).
  • Sputum pots – white topped universal containers
  • Swabs with bacteriological transport medium – store at room temperature.
  • Universal containers (plain).
  • Disposable cup (60 mL) for V-Monovette urine with integrated transfer device.
  • V-Monovette with boric acid (green top) – for urine bacteriology specimens.
  • EMU containers
  • ENT swabs (includes medium)
  • Blood culture bottles
  • Vacutainer tubes for blood samples.
  • 7 ml boric acid (red top) for paediatric urines.
  • Virus transport medium (VTM) and swab kit

Non-NHS samples

Category 2 and private specimens must be clearly indicated on the request form.

All work on prospective students of universities, or other institutions of further education (except rubella screening in females), is classified as Fee Paying Services and will, therefore, be charged at Category 2 rates.

Testing will only be performed where it is indicated to whom the bill should be sent.
Please ensure that your patients are aware that they will be charged for these tests before the specimen is taken.

Prices are available on request.

Specimen acceptance

General Sample Guidelines can be downloaded here.

Sample Acceptance/Rejection Criteria can be downloaded here

  • Do not send specimens in non-sterile containers.
  • Specimens should be obtained before antimicrobial agents have been administered.
  • An adequate quantity of material should be obtained for complete examination. Always send pus rather than a swab of pus.
  • The specimen taken should be representative of the disease process. For example, material swabbed from the opening of a sinus tract is more likely to yield commensal microorganisms on the skin than would material obtained by curettage or biopsy of the base of the tract.
  • Care must be taken to avoid contamination of the specimen by microorganisms normally found on the skin and mucous membranes. Sterile equipment and aseptic technique must be used for collecting specimens, particularly for those from normally sterile sites.
  • Specimens (other than blood cultures) should be stored at 2-8°C if immediate transportation to the laboratory is not possible. Fastidious organisms may not survive prolonged storage or may be overgrown by less fastidious organisms before culturing.
  • Specimens may not be suitable for testing if they are so inadequately labelled that the patient’s identification is in doubt, or if they have leaked or been contaminated. In certain circumstances every effort is made to inform the requesting doctor first.
  • Please contact the laboratory if there is any doubt about the best specimen to take or concerning the availability of a test.

Rejection of unacceptable specimens

Specimens and request forms are checked on receipt to confirm the patient identification (PID) information provided on the form and specimen agree. There are 4 PID data items; Surname, Forename, Date of Birth and ID Number (Hospital or NHS) which are required by the laboratory and these must match in order for the specimen to be accepted. It is good practice for us to have location and date & time of sample collection. If errors are found the laboratory may contact the requestor, explain the problem and request a repeat specimen.

For samples that are not easily repeated (such as CSF or paediatric samples) the problem will first be discussed with a BMS from the relevant section who will make a decision on whether testing may be allowed to proceed (usually after discussion with the clinician concerned). If the specimen is tested the report will clearly state the nature of the problem as a comment. Alternatively, the requesting clinician will be asked to send a repeat sample.

For further details regarding incompletely labelled samples or forms please contact the laboratory.

 

Packaging and Transport of Samples

Specimens are a potential source of infection and should be treated accordingly. Please fill all specimen bottles with the correct volume of blood to ensure correct anticoagulation, and all containers should be securely closed. Leaking specimens with gross contamination of contents and containers are discarded. Pocket bags are available for specimen transport. NB: Form and specimen must not be in the same bag. Specimens should be placed in the appropriate container, which must be securely fastened. This must be placed in a clear plastic bag and sealed. Refer to local Trust policies. High Risk samples should be appropriately labelled on both the request form and specimen.

The transport of samples from GP surgeries or other primary care locations is carried out by the Logistics service staff who will collect all samples from dedicated collection points. Specimens from within the hospital can be transported to Pathology either by the Pneumatic Tube System (PTS) if suitable, and/or by a porter. For urgent samples ward staff are required to arrange delivery to the laboratory. Specimens must first be placed in the plastic specimen bags together with the completed request form.

The best results are obtained when an appropriate, well taken specimen, in the proper container, is delivered to the laboratory promptly and relevant clinical information is provided on the request form. Delays can render the samples unusable, if immediate transportation to the laboratory is not possible blood specimens for microbiology/virology should be stored at 2-8°C, for biochemistry, haematology & immunology specimens should be stored at room temperature until transported to the laboratory.

The safe transport of specimens to the laboratory is the responsibility of the requesting doctor or carrier. Laboratory responsibility for the specimen begins when it has arrived at the laboratory. All samples delivered to laboratory reception from wards, in-patients, out-patient clinics and patients are carried to NNUH by a dedicated service, along with all GP ICE requests.

Sending Samples

The transport of samples from GP surgeries or other primary care locations is carried out by the Logistics service staff who will collect all samples from dedicated collection points. Samples from within the hospital can be transported to Pathology either by the Pneumatic Tube System (PTS) if suitable or by a porter. For urgent samples ward staff are required to arrange delivery to the laboratory. Samples must first be placed in the plastic sample bags together with the completed request form.

The safe transport of specimens to the laboratory is the responsibility of the requesting doctor or carrier. Laboratory responsibility for the sample begins when it has arrived at the laboratory.

Sending samples via the pneumatic tube system

  • All items MUST be sent in the carriers provided.
  • Samples MUST not be placed directly into the carriers. ALL Pathology samples MUST be placed in specimen bags and the lids of all items with the potential to leak (fluids etc.) tightly secured BEFORE placing them in the carriers.
  • Do not cram samples/items into the carrier as this may lead to breakage/leakage and system failure.
  • Only one carrier at a time should be placed in a delivery station.
  • Ensure that carriers are closed securely at both ends to avoid them jamming in the tube network.
  • If any defect is noticed with the operation of the air-tube systems please notify the laboratory at the earliest opportunity.
  • The system must not be used for sending consumables and other “forbidden items” around the hospital.

The air tube systems are for the transport of Blood Sciences specimens to the laboratories only.

The air-tube system should NOT to be used for:

  • Danger of Infection samples
  • Blood gases
  • Blood cultures
  • Unrepeatable samples
  • CSFs (for culture, protein, glucose or xanthochromia)

SEE INDIVIDUAL TRUST POLICIES.

Transport to Microbiology NNUH

During normal working hours:

  • Non-urgent specimens from NNUH should be taken/sent to Pathology Reception, East Block, Level 1, Norfolk and Norwich University Hospital; these will be delivered by routine van runs to the EPA Microbiology Department.
  •  Urgent specimens from NNUH should be taken to the Security desk at the West Atrium for delivery to the EPA Microbiology Department. The EPA Microbiology Department must be contacted to ensure that the specimen is dealt with immediately.

Outside normal working hours:

  • Non urgent specimens from NNUH should be taken/sent to Pathology Reception, East Block, Level 1, Norfolk and Norwich University Hospital, for delivery the following day to the EPA Microbiology Department.
  • Urgent specimens from NNUH should be sent to the Security desk at the West Atrium NOT Pathology and instructions given to send the specimen to the Microbiology Laboratory. Remember the Microbiology service is provided from the Norwich Research Park, Colney. The specimen will be sent to the Microbiology Department via the most appropriate available transport.

For more detailed information about out of hours specimens click here

“High Risk” samples

Medical officers responsible for the care of patients have a duty of care towards other members of staff – therefore all samples from patients who are known to have, or strongly suspected of having the conditions noted below must be identified.

  • Creutzfeldt – Jakob disease
  • Viral haemorrhagic fever (VHF) of any type
  • Microorganisms, (biological agents) in Hazard Group 3 or 4.
  • Pyrexia of unknown origin (PUO) recently returned from Africa.

Medical staff should ensure that appropriate information, including relevant travel history, is provided in order to alert laboratory staff of potential dangers. Clinical details supplied on sample request forms must contain clear information regarding the nature of the test being requested and sufficient detail to inform laboratory staff upon the safety precautions they need to take in order to process the sample without risk of infection.

If, during patient intervention, further information becomes available that has implications for the safety of laboratory staff this must be communicated immediately to the laboratory so that appropriate steps regarding containment can be taken.

Contact details for the Infection Protection and Control Nurses:

Mon-Fri 09:00 – 17:00
Tel 01603 289847 (Ext: 5847)

Email: IP&Cadministrator@nnuh.nhs.uk

Out of hours: First contact the relevant site practitioner. 

Results

Authorised results are available on the ICE system for those sites with access, which is updated regularly throughout the day.

Written results are printed and reported every working day including Saturdays. Apart from negative urines, which can be reported after one working day, most bacterial culture results are reported after 2 – 5 days depending on the investigation.

Virology/Serology reporting depends on the investigation required, the frequency of testing and the urgency of the request.

Serology and Virology

Successful diagnostic virology depends upon the correct timing and selection of clinical specimens and their collection and transport to the laboratory under appropriate conditions. Often the same clinical syndrome can be produced by a variety of viral agents and clinical differentiation of the specific infecting virus may be difficult if not impossible. Generally viruses are shed for only a few days before and after the onset of symptoms and therefore specimens for viral detection should be taken as early as possible in the illness.

Many viral infections are asymptomatic and some viruses may be excreted intermittently from various sites for prolonged periods of time. When a viral infection is diagnosed, either by virus detection or serologically, its significance and relevance to the illness under investigation can be determined only by careful consideration of the clinical picture.

If in doubt please contact the Duty Virologist during normal working hours or the on-call Consultant Virologist out of hours, if urgent.

Significant results are telephoned where clinically indicated.

Many tests can be processed urgently if clinically indicated, and after discussion with Duty Virologist.

Results of urgent requests if ICE access or electronic delivery is not available and unexpected results, which may aid the immediate patient management, will be telephoned.  This includes all positive blood cultures and CSFs.

In the event that the laboratory is unable to deliver the required service, e.g. due to equipment failure we will endeavour to contact all relevant users.

Due to IG compliance requirements, results cannot be communicated directly to patients. 

Leaflets

Guidance

Guidance and Algorithum for Diagnosis of / Appropriate Sampling for Urinary Tract Infection in Adults > 65 Years Without A Urinary Catheter

https://www.easternpathologyalliance.nhs.uk/wp-content/uploads/2022/05/MSU-Guidance-for-over-65s.pdf

Opening Times

The lab operates outside the core hours but is routinely staffed and most responsive during the following times.

Core Hours:

Monday09:00 - 17:30
Tuesday09:00 - 17:30
Wednesday09:00 - 17:30
Thursday09:00 - 17:30
Friday09:00 - 17:30
Saturday09:00 - 12.30
SundayClosed

 Laboratory Operational Hours

Monday08:00 - 21:00
Tuesday08:00 - 21:00
Wednesday08:00 - 21:00
Thursday08:00 - 21:00
Friday08:00 - 21:00
Saturday08:00 - 20.00
Sunday08:00 - 20.00
Bank Holiday 08:00 - 20:00

During these times the Department’s telephones are fully manned and we will be able to respond to most requests.

Special or unusual tests may have to be analysed in batches and may not be available outside the laboratory’s core hours.

Outside the core working hours the on-call consultant can be reached via the hospital switchboard.

 

Specimens will be processed outside normal laboratory hours if requested and agreed criteria are satisfied. For more information click here.

Outside of the operational hours the examination of urgent specimens is undertaken by a team drawn from the most experienced Biomedical Scientists (BMS) in the department.  A Medical Microbiologist and Consultant Virologist provide clinical cover at all times.

Specimens are accepted by arrangement with the on-call BMS who is reached via the NNUH switchboard for NNUH / Norwich GP specimens, and via the local Blood Sciences Laboratory for JPUH and QEH samples (see Packaging and Transport of Samples). With few exceptions specimens should be obtained before telephoning the BMS.

 The specimen and request forms must be labelled clearly as URGENT and need a doctor’s name and bleep number to facilitate communication of initial results.  Some requests however are only accepted after consultation with the on-call Medical Microbiologist/Virologist as appropriate and these are marked in the guide.  Inappropriate requests will be deferred to the following morning.

Location

There is no facility for patients or other individuals to drop off mail or specimens at the laboratory location – please use Pathology on Level 1 East Block on the main NNUH site.

Phlebotomy, level 3 for blood tests.