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The NANOGRAM

Martha Jefferson Hospital Laboratory Services

Spring 2018

Quarterly Newsletter on Charlottesville Pathology Website

This newsletter is from the Laboratory and will be distributed on a quarterly basis. It contains important information and news briefs concerning laboratory services. In addition to normal distribution, each issue will be posted at www.cvillepathology.net under the News Brief section.

Blood Culture Identification Panel by PCR (BCID)

On March 22, 2018 the Micro lab went live with the Blood Culture ID by PCR (BCID) using the Biofire FilmArray With the ability to detect 23 organisms and 3 resistance mechanisms, the BCID panel will enable the lab to quickly report an ID and antimicrobial resistance gene to the physician. This will also enable the pharmacy to provide an effective therapy, de-escalate from broad spectrum antibiotic, if necessary, to a more narrow-spectrum antibiotic sooner than conventional culture methods and utilize the narrow spectrum therapies to decrease harmful effects to patients.

The BCID Panel will identify the following Bacteria, Yeast, and Antimicrobial Resistance Mechanisms:

 

Gram-Positive Bacteria                           Gram-Negative Bacteria                                           Yeast

Enterococcus                                        Acinetobacter baumannii                                     Candida albicans

Listeria monocytogenes                         Enterobacteriaceae                                             Candida glabrata

Staphylococcus                                    Enterobacter cloacae complex                               Candida krusei

Staphylococcus aureus                          Escherichia coli                                                   Candida parapsilosis

Streptococcus                                       Klebsiella oxytoca                                               Candida tropicalis

Streptococcus agalactiae                         Klebsiella pneumonia

Streptococcus pneumonia                      Serratia marcescens                                     Antimicrobial Resistance Genes

Streptococcus pyogenes                         Proteus                                                          mecA - methicillin resistance

                                                           Haemophilus influenza                                     vanA/B – vancomycin resistance

                                                         Neisseria meningitides (encapsulated)                  KPC – carbapenem resistance

                                                         Pseudomonas aeruginosa

Specimen: Human blood culture samples identified as positive by continuous monitoring blood culture system that demonstrates the presence of organisms as determined by gram-stain.

The BCID Panel will be performed as part of the blood culture work –up when the culture become positive. A gram stain will still be performed first, with results called to the physician.

Please contact SMJH Lab Services with any questions at 434-654-7170.

Coagulation Tube Filling

It is important to remember that our 2.7 ml blue top coagulation tubes need to be filled properly in order to get accurate results. If the plasma to anticoagulant ratio is not correct the results will not be reliable. Our current instrumentation will automatically reject any specimen that is under or overfilled. If you use a butterfly to draw you should use an extra tube to draw off the air volume in the butterfly tubing before filling the blue top tube.

Please be sure that all blood levels for these tubes exceed the minimum fill line and that the tube is not filled past the maximum fill line.

Welcome to New Lab Managers

Debbie House has accepted the position of Administrative Manager and will move into Bette Webber’s role effective April 1st. Debbie is moving into her new role from Hematology where she was the Senior Tech.

Carl Lake has accepted the position of Outreach/Marketing Manager and will move into Carolyn Dotson’s role effective April 1st. Carl is moving into his new role from the Infusion Center Lab where he was the Senior Tech.

Congratulations!

Retirements

 It is with mixed emotions and sincere gratitude for their service that SMJH Lab Services announces the retirement of Carolyn Dotson and Bette Webber effective Friday, May 4th 2018. Both Carolyn and Bette have held numerous positions in the lab from phlebotomist to bench Med Tech, Section Leader, and Manager. They have been dedicated, committed leaders who have helped move the lab forward by leaps and bounds over the course of their career. A complete list of their contributions to the hospital and Lab are too numerous to list but below is a very short list of some of their accomplishments.

Carolyn has given 36 years of service to MJH Lab Services. Carolyn pioneered the Lab Outreach business. She handled all aspects of Outreach from establishing and maintaining relationships with community physicians and staff, building EMR interfaces, billing and troubleshooting. She oversaw the implementation of the very first lab information system (Sunquest) for the hospital in 1986, to Cerner in 1999, and the implementation of Epic Beaker and Safetrace in 2016.

Bette has given 40 years of service to MJH Lab Services. She started as a phlebotomist working her way through Med Tech school. As a Section Leader for Blood Bank, Bette oversaw the implementation of the first lab info system (BB Sunquest). As Lab Admin Manager, Bette has overseen a plethora of new projects including numerous relocations for inpatient and outpatient phlebotomy, leading employee training for Epic Beaker go-live, developing a streamline interviewing process, hiring employees, and maintaining all employee records for orientation, training, competency. She has also been the HR liaison for Lab Services.

Carolyn and Bette will be greatly missed. Please join us in congratulating them on their well-deserved retirement

Thin Prep & Sure Path Liquid Based Cytology

Occasionally there is marketing comparing these 2 tests sent to the offices. Please know that our team has reviewed both tests and have selected the test that is accurate, best for SMJH practitioners, and all-inclusive. If there are questions about any marketing you receive, please call SMJH Cytology to discuss at 434-654-5903 or email . Ann L. Lewis, Sr. Tech, in Cytology can help you.

ANA Testing Availability

On April 10th, 2018, SMJH Laboratory will offer ANA Screens in house.

LAB4281 ANA w/ Reflex – This will include an ANA screen performed on the BioPlex multiplex flow immunoassay analyzer. If positive it will reflex to report out a quantitative dsDNA, RNP Antibodies, Smith (Sm) Antibodies, Sjogrens A (SS-A) Antibodies and Sjogrens B (SS-B) Antibodies.

LAB4475 ANA Comprehensive Panel - This panel will be performed on the BioPlex multiplex flow immunoassay analyzer. This panel will include dsDNA, RNP Antibodies, Smith Antibodies, SS-A Antibodies, SS-B Antibodies, Jo-1 Antibodies, Scl-70 Antibodies, Centromere B Antibodies, and Chromatin Antibodies.

Any of these components can also be ordered individually. Any questions can be directed to the lab at 434-654-7170.

Meningitis/ Encephalitis by PCR

On Jan 3, 2018 the Micro lab went live with the new Meningitis/Encephalitis Panel by PCR. The Pathogens covered by this test include:

Escherichia coli K1

Listeria monocytogenes

Cytomegalovirus

HHV-6

Cryptococcus neoformans/gattii

Haemophilus influenza

Enterovirus

Neisseria meningitidis

Human parechovirus

Streptococcus pneumonia

Streptococcus agalactiae

HSV 1 & 2

Varicella Zoster

Non-K1 E coli serotypes & Non encapsulated strains of Neisseria meningitidis may be present but not be detected by the Film Array ME Panel.

Specimen Requirements: 1 ml of CSF obtained by lumbar puncture. For this test, Micro will need to use Tube #2. The test is not orderable in the system. It will be ordered by Micro as part of CSF culture automatically unless Micro is notified that it is not necessary to run the ME Panel by PCR.

Note: CSF collected from indwelling medical devices (e.g. shunts) is NOT ACCEPTABLE for this testing.

Questions can be directed to Micro at 654-7170.

Important Telephone Numbers

o Need lab results from the Clinical Lab call 654-7170 or fax 654-7164.

o Need lab results from the Anatomic Pathology Lab 654-7955 or fax 654-7944.

o AP Client Services Representative, Noel Jorgensen, at 654-5525.

The next Nanogram newsletter will be Summer 2018 distributed in July 2018.