Clinical Microbiology Laboratory Test Requisition
Eboni Kleifgen
The Mission of Laboratory Services is to provide high quality analytical services of medical and environmental testing and to achieve the Mission of the Department of Health.The Tennessee Department of Health (TDH) Laboratory Services consists of the Microbiology Laboratories and Environmental Laboratories in Nashville and Knoxville. The central laboratory is housed in Nashville in a dedicated facility with state of the art equipment. The laboratory consists of 125 full time employees.The Microbiology Laboratories are licensed by the State of Tennessee Laboratory Licensing Service (LLS) and certified by the Department of Health and Human Services Centers for Medicare and Medicaid Services (CLIA Laboratory Certificate of Compliance) to perform clinical testing. The laboratories perform a wide range of microbiological testing in the areas of Bacteriology, Molecular Biology, Environmental Microbiology, Mycobacteriology, Parasitology, Mycology, Immunoserology, Virology, and Newborn Screening. Laboratory Services is also the State Emergency Preparedness Laboratory for biological agents.The Environmental Laboratories in Nashville and Knoxville are certified by the Environmental Protection Agency (EPA) under the Safe Drinking Water Act. Each laboratory follows guidelines, regulations, and methodology as prescribed by the EPA, the Nuclear Regulatory Commission (NRC), and other federal or state programs. The Environmental Laboratory consists of the Chemistry, Radiochemistry, Aquatic Biology, and Chemical Terrorism Laboratories. The Environmental Laboratories perform testing in support of other state departments such as the Department of Environment and Conservation, Department of Labor, and the Department of Transportation.
Submission of requests for laboratory testing should be accompanied by the appropriate requisition form. Laboratory procedures are performed ONLY upon a physician's written request. All verbal requests for additional test requests to be added to a written order must be followed by written confirmation within 30 days. CLIA-88, and thus the Joint Commission and the College of American Pathologists (accrediting agencies) require that each requisition form for laboratory services must clearly identify:
The IDPH Division of Laboratories works closely with the IDPH Division of Infectious Diseases to protect people from infectious diseases through disease surveillance, analysis, immunization, and education by performing or assuring the ability of laboratory tests. Laboratory subject matter experts are available to consult on Communicable Diseases, HIV/AIDS, Sexually Transmitted Diseases, Vaccine Preventable Diseases as well as Novel Diseases. The Illinois Department of Public Health Laboratory Services Manual is located in the Resources section of this page and provides a description of all clinical tests available at the laboratory.
The Division of Clinical Microbiology is comprised of a team of clinical microbiologists, pathologists, and medical technologists. We provide services in bacteriology, mycology, mycobacteriology, parasitology, serology, virology, and molecular microbiology. We offer 24/7 specimen processing and testing in the following areas: blood cultures, malaria, stat gram stain reading, stat fungal stains, stat serologies, rapid tests, molecular respiratory virus testing and Clostridium difficile testing. Routine bacterial and viral cultures, antimicrobial susceptibility tests, chlamydia/gonorrhoeae/trichomonas nucleic acid testing and viral loads are run seven days per week during dayshift hours 8 am to 4 pm. We run specialized testing including mycobacteriology, routine serology, routine mycology, ova and parasite exams, and quantiferon gold testing on Monday through Friday 8 am to 4 pm. In addition, we forward testing to a variety of specialized public health labs including the New York City Department of Health and Mental Hygeine, the Wadsworth Center, National Jewish Respiratory Institute, and the Centers for Disease Control and Prevention.
Stat gram stains are performed on cerebrospinal fluid and surgical specimens. The lab performs testing for Clostridium difficile on liquid stools 24 hours a day Monday through Fridays and 9 am to midnight weekends and holidays with a two-hour turn-around-time for specimens sent directly to Microbiology (Tube Station 74). We also perform 24/7 rapid molecular testing for Influenza and Respiratory Syncitial virus from nasopharyngeal swabs and aspirates placed into viral transport media and transported to the lab.
In addition to C. difficile PCR, the laboratory will perform pre-surgical screening for S. aureus and Methicillin-resistant Staph. Aureus (MRSA) from nasal specimens and measure HIV-1, hepatitis C virus , hepatitis B virus, and cytomegalovirus levels (viral loads). We offer nucleic acid tests (Hologic APTIMA) for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas on a variety of specimen types. We also offer a 20-target respiratory PCR panel that includes all major respiratory viruses and 3 bacterial targets: Bordatella pertussis, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. First time positive sputum smears are all analyzed via tuberculosis (TB) PCR. We also perform Quantiferon Gold testing for TB screening. We are in the process of validating more molecular tests with the aim of significantly expanding the molecular microbiology menu.
Dr. Hamula is a founding member of the Mount Sinai Pathogen Surveillance Group, which has developed a pipeline for whole genome sequencing of outbreak associated isolates in real-time. She is currently working on expanding whole genome sequencing analysis for clinical use.
The laboratory recently acquired a MALDI-TOF MS for routine bacterial identification and a set of BioFire FilmArray instruments, on which we currently run the respiratory pathogen panel. We are in the process of validating the BioFire Stool GI pathogen panel for diarrheagenic stools with planned implementation in the fall 2016. We also have a GeneXpert Infinity to perform Real-Time PCR testing for a variety of targets. Both the GeneXprt and FilmArray have rapid turnaround times (within two to four hours of receipt in lab). These systems use self-contained cartridges where sample extraction, PCR amplification, and detection occurs. This hands-free, self-contained operation allows this instrument to be used for stat testing as no batching of specimens is required.
The Infectious Disease Diagnostics Laboratory at The Children's Hospital of Philadelphia is a state-of-the-art facility which performs diagnostic testing for the detection of a wide range of human pathogens, including aerobic and anaerobic bacteria, yeasts and molds, enteric and blood parasites and viruses. We utilize a variety of molecular techniques as well as traditional methods to provide high-quality, timely results to providers.
Our laboratory team members work with healthcare providers to facilitate specimen collection, handling and transport, and to assist in the selection of the most appropriate tests(s) for your patient. We are also available to assist you in the interpretation of test results.
As a component of a renowned clinical, teaching and research environment, the members of the Infectious Disease Diagnostics Laboratory at CHOP can offer abundant expertise and support through our access to the knowledge and experience of distinguished researchers, educator and clinicians. Our team of professionals takes a personalized approach to providing high-quality and timely results to healthcare providers as well as providing follow-up information when requested. All of this assures that you have excellent counsel and assistance in caring for your patients.
For information about the Clinical Microbiology Fellowship Program, which is a joint program with the Hospital of the University of Pennsylvania, please visit the Clinical Microbiology Fellowship page.
Consistent with O. Reg. 671/92 of the French Language Services Act, laboratory testing information on this page is only available in English because it is scientific or technical in nature and is for use only by qualified health care providers and not by members of the public.
Neisseria gonorrhoeae (NG) culture is recommended plus NAAT when suspecting antimicrobial resistance, test of cure, symptomatic patients, pelvic inflammatory disease (PID), pregnancy, and sexual abuse/sexual assault.
First-void urine is the specimen of choice for males. A vaginal swab is the specimen of choice for females. In women who have had a hysterectomy, collect a first void urine for NAAT or a vaginal swab for culture or NAAT. Refer to the Specimen Collection and Handling section for additional acceptable specimen types.
Rectal and/or pharyngeal testing in individuals who have had exposures at these sites and are not in specific risk groups above may be considered in individual circumstances based on clinical evaluation or local epidemiology.
Rectal bacterial sexually transmitted infections, including CT and NG, have been associated with increased risk of HIV infection in gay, bisexual, and other men who have sex with men, and transgender women. Screening for HIV is highly recommended in these individuals. Details about HIV serology testing at PHO can be found on the HIV Serology Test Information Sheet. Consider initiation of Pre-Exposure Prophylaxis (PrEP) for HIV-negative individuals. For more information on PrEP, refer to ontarioprep.ca.
The transport media contained in the swab collection kit is in the optimal volume required for accurate testing and should not be adjusted. If the collection kit tube contents are spilled, discard and replace with a new Roche cobas PCR Media Dual Swab Sample Kit or PCR Urine Kit. Failure to use a new kit may invalidate test results. Clean spills with a suitable detergent and water. Do not use sodium hypochlorite (bleach) or other highly reactive reagents, or a noxious gas could be released.
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