News

Biotin Alert – Potential assay interference

June 15th, 2018

Potential Assay Interference – Biochemistry Immunoassay Tests

The immunoassay methods used in the Biochemistry laboratory at Exeter Blood Sciences use a streptavidin-biotin system in their design. If patients are taking large doses of Biotin (Vitamin B7), there is potential for interference in immunoassays analysed within Biochemistry. Keep on reading!


New Satellite Blood Culture Incubator in Blood Sciences

June 14th, 2018

Microbiology and Blood Sciences have collaborated to set up a satellite BC incubator in the A2 template. This will allow incubation of all  blood culture bottles immediately they arrive in the lab. For our patients, this means:

  • Faster results
  • Shorter turnarounds
  • Earlier optimisation of antibiotic use
  • Less use of potentially nephrotoxic agents (particularly relevant in the Neonatal Unit)

What do you need to do?
Take blood cultures as normal
9am – 5pm:        pod (2900) to Old Path block as you do currently
After hours:       pod (2912) to A2 template, they will be loaded on the satellite unit overnight & repatriated to Microbiology the following morning

Your results will likely come back ~12 hours earlier – we will monitor this.


Update on Rubella Screening in Pregnancy

June 12th, 2018

Prepared from PHE letter by C Auckland; RDE 2018

Antenatal screening for rubella (German measles) susceptibility ended in England on 1 April 2016. The decision to stop screening followed a review of evidence by the UK National Screening Committee (UK NSC) in 2003 and 2012 which on both occasions found that screening for rubella susceptibility during pregnancy did not meet the UK NSC criteria for a screening programme.

The epidemiology of rubella in the UK has changed due to the high uptake of the Measles, Mumps and Rubella (MMR) vaccination in the UK population, both boys and girls. Women are now unlikely to be exposed to rubella in pregnancy. The few cases that occur are usually imported from other countries.

The rationale to end screening for rubella susceptibility includes:

  • rubella infection in the UK is at a level defined as eliminated by the World Health Organisation
  • screening for rubella susceptibility in pregnancy does not give any protection to the unborn baby in the current pregnancy
  • the test may falsely reassure some women that they are not susceptible to rubella infection in the current pregnancy
  • stopping antenatal screening is unlikely to result in increased rates of congenital rubella. There were 12 cases of congenital rubella reported in the UK between 2005- 2015. None of these could have been prevented by the screening programme. We will continue to monitor cases following the cessation of rubella susceptibility screening
  • the MMR vaccine is effective in protecting women against rubella in pregnancy

The MMR section 7A service specification sets out that providers are required to make the MMR available to women of child bearing age who are unvaccinated or partially vaccinated for rubella and other adults and children who have no history of MMR vaccination, or incomplete immunisation status.

Existing opportunities should be taken for checking the status and administration of MMR vaccination (two doses if needed) for:

  • all children and young adults who have not been vaccinated
  • new entrants to the UK at General Practice registration consultation
  • postnatal women through health visiting assessments and six week maternal checks
  • women accessing preconceptual; fertility or miscarriage and termination services

What you can advise patients

If pregnant women request Rubella testing, they should be advised that it is no longer part of the NHS antenatal screening programme; that they should check whether they have had 2 x MMR vaccinations, and if they have not, book an appointment to have a MMR vaccination at the 6 weeks post-natal check.

Check all new entrants from EU have had x2 MMR

PHE have published the following resources which can be given to patients:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/696849/Screening_tests_for_you_and_your_baby.pdf

References

https://phescreening.blog.gov.uk/wp-content/uploads/sites/152/2016/03/Gateway-letter-cessation-date-for-antenatal-rubella-screening.pdf

http://legacy.screening.nhs.uk/rubellasusceptibility


PVSA Request Form *UPDATE*

April 24th, 2018

Please use updated PVSA request form for all future PVSA requests.


Important recommendations for implementation of Whole Genome Sequencing in the NHS published

April 23rd, 2018

The House of Commons Science and Technology Committee have published their report “Genomics and genome editing in the NHS” on the use of whole genome sequencing (WGS) within the NHS. It includes important recommendations for the UK government which will have significant implications for patients, clinicians, NHS genetic/genomic diagnostic services and the UK genomics industry.

The report has been authored following consultations with NHS genetics services (including Professor Sian Ellard, Head of the Department of Molecular Genetics in Exeter), experts in UK genomics research and industry, patient advocacy groups and independent think tanks at several science and technology select committee hearings and information gathered from other sources, such as the Chief Medical Officer’s “Generation Genome” report (published July 2017).

Full details of the report can be found using the above link or a short summary is available on the Genetics News Page.


Microbiology News Update – Minor changes to Urine Culture Methodology

March 13th, 2018

As part of our commitment to continually improve our diagnostic capacity, we are making some changes to urine culture to bring us into line with the National Standard Methods (NSM).

Please continue to use the PHE Urinary Tract Infection guideline when evaluating patients with potential UTIs (though this is being updated shortly)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/619772/Urinary_tract_infection_UTI_guidance.pdf

The changes are:

  1. Introduction of chromogenic agar to improve our identification of urinary coliforms.
  2. We are limiting our confirmatory testing for resistance markers. These 2 changes will enable us to issue more results at ~ 24 hours.
  3. Alteration to the cut-offs used to define significant bacteriuria in line with NSM. This will mean you will see different colony counts on the results; we will still only report significant bacteriuria. The advice on whether to treat remains unchanged (i.e. Treat SYMPTOMATIC cases only except in pregnancy)
  4. We have amended the electronic ordering – hopefully the questions are now more relevant and easier to complete (GP Ordercoms will be available in the next 12 months).
  5. You do not need to add the result of a dipstick to the request, but please include planned and previous antibiotic therapy in the clinical details, so we can tailor our result to your patient.

We are always pleased to receive feedback (good and bad) so please contact me if you want to discuss these changes.

Cressida Auckland,  Consultant Medical Microbiologist

cressida.auckland@nhs.net

 


Microbiology News Update – New culture method for Mycobacteria spp

March 13th, 2018

We are pleased to announce the introduction of the BD MGIT – a new liquid culture method for Mycobacterium spp which will replace solid media. We will switch over to this test on 5th March 2018.

The BD BACTEC MGIT Instrument is an in vitro diagnostic instrument designed for the rapid and automated detection of Mycobacteria spp from clinical specimens (except blood).

Positive culture tubes are examined by ZN and Auramine staining for the presence of acid-fast bacilli (AFBs), and then referred to the Mycobacterial Reference Laboratory for further identification and sensitivity testing. We will continue to inform clinicians/wards/public health at every stage of the diagnostic pathway.

 All types of clinical specimens, pulmonary as well as extrapulmonary are accepted (except blood).

This method has 2 advantages over traditional culture:

  1. It is faster – we expect to isolate Mycobacterium tuberculosis in 1-4 weeks (with ~half by 2 weeks) rather than 4-6 weeks. This means we will issue a negative report at 6 weeks – this will be the final report.
  2. It is more sensitive – this method will (likely) detect all Mycobacteria spp. In the short term we will continue to culture on LJ slopes to further validate this methodology.

Microbiology News Update MGIT feb 2018


Genetic Technologists positions available

February 25th, 2018

We are excited to announce that applications are now open for two Assistant Genetic Technologists in our state-of-the-art facilities providing a high quality, rapid diagnostics service.

These roles are suitable for newly qualified applicants and full training will be given. The positions are full-time on one year fixed term contracts and the deadline for applications is 9th March 2018.

Please see the NHS jobs website  (reference 185-A-18-52544) for full details of the posts, contact details and application information.


Cellular Pathology User Survey Feedback

February 2nd, 2018

Many thanks to those of you who took the time to complete the Cellular Pathology user survey in 2017

You said
The secretaries are always very helpful and reports easily accessible.
• The Team are always extremely helpful with any queries I have and do their best every time.
• Can we track where you are with reporting results via this system? It would save us having to keep calling to chase results etc.
We said
• We are pleased that our team are always helpful. Results are available electronically within the hospital. For any queries regarding reports, please e-mail
rde-tr.Exeterhistology@nhs.net or contact the Secretaries directly on 01392 402942.

 

You said
The turnaround does appear to be quite outdated – not with the processes of the diagnostics but the admin processes to get the reports ready but the Laboratory staff use the tools they are provided with to the best of their ability.
• Often waiting for results
• With regards to the overall service of reporting histology / cytology I feel better technology could be used to speed up the process and help alleviate the workload on the Admin Team.
We said
• We are currently in the process of investigating alternative IT systems to improve the reporting process.

 

You said
New appointments over the last 8 years have really helped.
We said
• We are expanding our team in order to continue to meet the requirements of our service users.


Cytology User Survey Feedback

January 31st, 2018

Many thanks for those of you who took the time to complete our user Cytology survey in 2017

You said
If a colposcopy clinic referral is indicated from result it would be better if there is a choice for the woman – our surgery comes under the NDDH ‘umbrella’ but for a lot of our patients Exeter is far more convenient and given a choice that would be their preference.
We said
• Women are referred to a colposcopy unit according to their GP surgery location. However the GP surgery can change their preferred referral pathway to any colposcopy unit they wish. Women also have an independent choice and can choose where they attend. Please contact the laboratory for further information.

 

You said
Teach smear takers to take smears in left lateral position – so much more comfortable for the patient and easier to get good visualisation of cervix. Many of my patients have asked me to put this idea forward so that it is offered in other practices.
We said
• This idea has been forwarded to Mary White for discussion at the Sample Taker Training Updates. We are sorry but the laboratory cannot deal with this directly.

 

You said
Open Exeter could be easier to use and e-mails more helpful when queries are sent in.
• The Open Exeter website is clunky and difficult to use and required very frequent changes of password, as an occasional (GP) user this is frustrating. I would prefer a link to the clinical system which can then print the form.
We said
• Unfortunately the laboratory is not in control of the Open Exeter IT system. Please can you send your feedback regarding the Open Exeter System to:

NHS Digital
Helpdesk: 0300 303 4034
Email: exeter.helpdesk@nhs.net
Website: http://digital.nhs.uk/