Guidance

Birmingham Public Health Laboratory: user handbook

Published 21 March 2024

The UKHSA Public Health Laboratory for the Midlands

The UKHSA public health laboratory in Birmingham provides clinical diagnostic microbiology services. It also offers a range of public health microbiology services.

These include:

• a full range of tests to investigate any event or outbreak of possible public health significance in the community
• advice on the best diagnostic strategies to be adopted
• advice on interpretation of test results and additional investigations that may be helpful
• support to incident/outbreak investigation teams
• prompt communication of results in agreement with published turnaround times
• follow up/clearance testing of patients, or contacts of patients, in whom organisms of public health importance are detected
• support for NHS Trusts and health protection teams (HPTs) in the specialist investigation of health care associated infection

These public health microbiology services are available to:

• staff in HPTs
• local authority staff and directors of public health
• clinical commissioning groups (CCGs) and clusters
• acute Trusts

The laboratory is part of a network of specialised UKHSA laboratories across England (including laboratories testing food water and environmental samples) and including the major reference units at UKHSA Colindale and UKHSA Porton.

This user manual describes the provision of and access to public health microbiology services and gives contact details for the laboratory and its key personnel.

The UKHSA National Mycobacterium Reference Service - Central and North (NMRS -Central and North) is also located within the Birmingham Public Health Laboratory.

The principal activities of the unit include the:

• provision of a mycobacterial reference service based on whole genome sequencing for identification of mycobacterium species isolates
• prediction of drug susceptibility and resistance
• determination of relatedness for detection of transmission and investigation of outbreaks

Phenotypic drug susceptibility testing is carried out for selected M. tuberculosis (M TB) complex and non-tuberculosis mycobacterial isolates.

Extended testing is carried out for M TB complex isolates with resistance to first line agents.

The laboratory also offers:

• primary isolation service including microscopy and culture
• urgent polymerase chain reaction (PCR) service for detection of M. tuberculosis complex and rifampicin (and multidrug) resistance.

The NMRS - Central and North provides information and advice to clinical and public health teams for the identification and investigation of outbreaks and tuberculosis (TB) transmission. Our activities support surveillance activity for TB in the UK.

For further information please refer to the NMRS - Central and North user manual.

Key contacts

Incidents or outbreaks

In the event of a suspected outbreak or incident during normal working hours, contact the duty clinical microbiologist at 0121 424 3240 so that appropriate arrangements for investigation can be made.

Out of hours services, mentioned in further detail below, are available to cover:

• between 5pm and 9am on weekdays
• anytime on a weekend and bank holidays

Medical advice and general enquiries

During normal working hours, our medical staff will be happy to help you with any enquiries that you may have. Call 0121 424 3111 and our office will put you through to the most appropriate person.

For enquiries about laboratory results, call our office on 0121 424 3111 to be directed to the results enquiry telephone line.

Key laboratory personnel and contact details

Clinical laboratory

General enquiries, complaints or compliments, requests for specimen containers and/or courier services can be emailed to birminghamlab@ukhsa.gov.uk

Consultant in Public Health Infections (Midlands)

Kerry Roulston
Email: Kerry.Roulston@ukhsa.gov.uk
Contact number: 0798 923 2097

Clinical Services Director

Dr Abid Hussain
Email: abid.hussain@ukhsa.gov.uk
Contact number: 0121 424 2513

Head of Laboratory Operations (Midlands)

Sarah Gardiner
Email: Sarah.Gardiner@ukhsa.gov.uk
Contact number: 0121 424 1249

Laboratory Manager

Judith Workman
Email: Judith.Workman@ukhsa.gov.uk
Contact number: 0121 424 1225

Public Health Services and Acute Bacteriology Manager

Karen Reynolds
Email: Karen.Reynolds@ukhsa.gov.uk
Contact number: 0121 424 3250

Laboratory Administrator

Elizabeth Hill
Email: Elizabeth.Hill@ukhsa.gov.uk
Contact number: 0121 424 0717

National Mycobacterial Reference Service - Central and North Lead

Priti Rathod
Email: Priti.Rathod@ukhsa.gov.uk
Contact number: 0121 424 2510

Enteric Laboratory Lead

Raffan Ali
Contact number: 0121 424 3111

Duty Clinical Microbiologist

9am to 5pm (Monday to Friday)
Contact number: 0121 424 3240

Duty Clinical Virologist

9am to 5pm (Monday to Friday)
Contact number: 0121 424 2000

Laboratory Duty Manager Contact Number

Office hours: 0121 424 3250
Weekends and bank holidays: 0121 424 3111

Quality Manager

Caroline McKeon
Email: Caroline.Mckeon@ukhsa.gov.uk
Contact number: 0121 424 2510

Food, Water and Environment (FW&E) Testing Service (West Midlands)

• This role is currently vacant

Food, Water and Environment Testing Service (East Midlands)

Rob Johnston, FW&E Outposted Scientist
Email: rob.johnston@phe.gov.uk
Contact number (mobile): 07834 000 237
Contact number (direct dial): 0115 844 1304
Contact number (telephone): 0344 225 4524

UKHSA Food, Water and Environmental Microbiology Services (London laboratory)

UKHSA
61 Colindale Avenue
London
NW9 5EQ

Contact number 1: 020 8327 6548
Contact number 2: 020 8327 6550
Contact number 3: 020 8327 6551

Email: fwem@ukhsa.gov.uk

UKHSA Food, Water and Environmental Microbiology Services (Porton laboratory)

Porton Down
Salisbury
SP4 0JG

Contact number: 01980 616 766
Email: FWEPorton@ukhsa.gov.uk

UKHSA Food, Water and Environmental Microbiology Services (York laboratory)

National Agri-Food Innovation Campus
Block 10
Sand Hutton
York
YO41 1LZ

Contact number: 01904 468948
Email: yorkfwelab@ukhsa.gov.uk

Out of hours services

UKHSA Birmingham Public Health Laboratory provides an emergency out of hours service for urgent medical advice and to receive and process urgent clinical specimens.

Out of hours refers to:

• between 5pm and 9am on weekdays
  
• anytime on a weekend and bank holidays

During this time, you can reach the duty clinical microbiologist/virologist through Switchboard by calling 0121 424 2000. You can also use Switchboard to call staff for specific delivery arrangements out of hours.

Complaints procedure

Customers may raise concerns through various methods such as phone calls, letters or emails.

All customer concerns and complaints should be addressed to Caroline McKeon, Quality Manager. You can email Caroline at Caroline.McKeon@uksa.gov.uk

Laboratory location, working hours and access details

The UKHSA laboratory for the Midlands is based at:

UKHSA Public Health Laboratory Birmingham
Heartlands Hospital
Bordesley Green East
Birmingham
B9 5SS

This is also the laboratory’s postal address.

If sending samples or isolates to the laboratory by DX courier services, please use the following exchange number:

DX 6780100
Birmingham B

The laboratory is located at the rear of the Heartlands hospital site, accessible via the Yardley Green Road entrance. Entrance to the laboratory is made through the Pathology Specimen Reception or Pathology Visitors Reception, which is signposted.

Out of hours specimen delivery must be made to the Blood Bank. This is clearly signposted on entering the Yardley Green Road entrance as you approach the Pathology block.

See the Midlands public health laboratory website.

Laboratory working hours

Monday to Friday 7am to 8pm.

Weekends and bank holidays 8am to 4pm.

Please contact the laboratory in advance of submission with details of the incident or outbreak and investigations required.

Please notify the laboratory of the incident log number (ILOG) or outbreak identifier if one has been assigned. All non-urgent specimens should arrive in the laboratory within the hours specified. ILOG numbers can be obtained from the duty virologist or the enteric laboratory or by emailing birminghamlab@ukhsa.gov.uk

NHS laboratories and access to public health testing in the Midlands

All NHS laboratories have responsibilities for public health testing and reporting. The UKHSA Public Health laboratory provides additional services for health protection which includes providing support for the investigation of outbreaks, both locally and nationally, through:

• contributing to the formulation of local contingency plans and participation in exercises
• detection of local outbreaks through monitoring laboratory findings
• detection and prompt reporting of unusual occurrences of public health significance
• providing initial laboratory support for outbreaks incidents and look-back exercise as appropriate
• attendance of appropriate staff at local community control of infection meetings and incident/outbreak control team meetings
• advice on appropriate investigations and interpretation of results
• forwarding of appropriate specimens to reference laboratories

Initially, diagnostic patient specimens are likely to be examined at the local NHS laboratory. However, once an outbreak has been recognised and declared by the Health Protection Team (HPT) or other appropriate authority, there should be a discussion between the initial investigating NHS laboratory or HPT with the regional microbiologist or duty consultant microbiologist/virologist in the UKHSA public health laboratory to decide on testing of additional specimens and the method of transport.

If either the number of specimens expected is likely to exceed the capacity of the local NHS laboratory, or requires specialist tests, then the specimens should be referred to the nearest UKHSA laboratory.

If a local NHS laboratory is unable to provide this support at any time, for whatever reason, the UKHSA will make arrangements to ensure that these services continue to be provided.

If any difficulties with existing or new arrangements are encountered please contact the Public Health Services Manager on 0121 424 3250 or Head of Operations on 0121 424 1249 who will make sure that arrangements are securely in place.

Definition of a public health microbiology specimen

A public health microbiology specimen is usually submitted to determine the cause and extent of an outbreak in a community (institution, family group or the wider community) or to see whether an observed cluster of cases is related and constitutes an outbreak:

• specimens may also be submitted to detect spread and contain and/or prevent an outbreak for example diphtheria, group A streptococcus
• patient specimens may also be submitted for clearance purposes (for example faeces for E. coli O157) or to detect carriage of pathogens in asymptomatic individuals for example Salmonella typhi

The list below provides some of the circumstances in which public health specimens may be submitted (this list is not exhaustive):

• in the investigation of an outbreak for example diarrhoea and vomiting in a nursing home or other institution
• suspected food poisoning in a group or community
• respiratory symptoms in an institution for example suspected influenza
• to check for clearance of certain pathogens (see above) in individuals working in high risk situations such as  food handlers, those working with children or other vulnerable groups
• screening of contacts of index cases for example diphtheria, poliomyelitis
• look back exercises for example carriage of blood borne viruses in a health care worker
• TB contact tracing
• investigation of a cluster of cases of for example Legionnaires’ disease or invasive group A streptococcus, which could have a common source

Such specimens are usually submitted at the request of:

• senior staff of an HPT
• an environmental health officer
• at the request or on behalf of the Director of Public Health or consultant in communicable disease control
• at the instigation of the regional microbiologist for example for specialist typing in the investigation of episodes of health care associated infection

Collection of specimens

In order to provide the best quality results, it is essential that good specimens are collected properly and at the appropriate time. It is also important that they are transported to the laboratory safely and without undue delay (See Appendix 1 for safety considerations).

Inappropriate specimens or those that are inadequately labelled (see request form), damaged or leaking are liable to be discarded. Should this occur, every attempt will be made to inform the sender so that a second specimen may be collected. Both the request form and specimen container must be labelled with at least 2 patient identifiers, such as the:

• patient’s full name
• patient’s date of birth
• patient’s postcode
• hospital/clinic number or NHS number
• date the sample was taken

The above will assist us in the surveillance of communicable diseases.

Please provide full details of where to send the result and who to contact if we need to report an urgent, significant result. Please provide an Outbreak Number if available.

Sample collection and submission

Please ensure that all details are completed on the request form and sample container before it is given to the patient. Ask the patient to complete all details on the specimen container before collecting the specimen. These must include:

• first name
• second name
• date of birth

Faecal specimens

The specimen size must be at least 5ml.

The patient or carer must wear disposable gloves.

Please ensure that all details on both the specimen and accompanying request form are completed. Failure to do so will lead to rejection of the specimen.

Please give full clinical details and brief details of the outbreak on the request form.

In outbreak situations or when unusual pathogens may be implicated, it is essential to discuss the request with one of our consultant microbiologists before submission of specimens. An incident number (ILOG) should be allocated to each outbreak and included on the request form.

The faecal sample will be examined for the presence of:

• Salmonella
• Shigella
• E. coli O157
• Campylobacter
• Cryptosporidium and giardia species
• Clostridium difficile in all patients with diarrhoea over the age of 65 years and where clinically indicated (for example in nursing home or care home outbreaks)

Should you suspect any of the following pathogens, please discuss with the consultant microbiologist :

• Vibrio cholerae
• Diarrhoeagenic E. coli (other than E.coli O157)
• Yersinia enterocolitica
• Enteric parasites
• Food poisoning due to Staphylococcus aureus, Clostridium perfringens, or Bacillus cereus

Should the clinical history suggest infection with viral pathogens, this too should be clearly indicated on the request form. When a viral aetiology is suspected, faeces for virology will be routinely investigated for norovirus. Additional viral pathogens can be sought (adenovirus, astrovirus, rotavirus, sapovirus). Please discuss with the duty virologist.

Throat/pharyngeal swabs (pink top swabs)

For the detection of carriage of Neisseria meningitidis, the swab must be taken through the mouth (sweeping posterior pharynx behind the uvula).

For the detection of Group A streptococcus, swab the tonsillar area.

For the detection of Corynebacterium diphtheriae, nose and throat swabs must be submitted. If infection with Corynebacterium diphtheriae is suspected on clinical grounds, a microbiologist must be contacted without delay (without waiting for confirmation by culture). One suspected case of diphtheria requires urgent public health action.

Viral respiratory specimens (green top swabs)

Occasionally outbreaks of influenza occur in institutions. The incident management team will advise when specimens from these outbreaks need to be submitted. Please seek the advice of the duty virologist on what specimens are required and how these can be submitted. Flu kits can be obtained from the laboratory (and include instructions for collection).

Sputum

Please contact the laboratory to discuss the submission of specimens. If you need to submit sputum specimens for examination for the presence of mycobacteria, for example in cases of suspected tuberculosis, please contact laboratory consultant medical staff for advice and discussion before submitting any specimens.

Urine

Fresh urine specimens (in a clean universal container) may be required for the diagnosis of Legionnaires’ disease.

Serum

Specimens of clotted blood for:

• investigation of clusters of atypical pneumonia
• look back exercises to detect the transmission of blood borne viruses by arrangement with laboratory/incident or outbreak management team

Methods of specimen submission

Direct submission to the laboratory

This method of submission is available to all local authorities submitting samples to the laboratory. See the laboratory location, working hours and access details for specimen drop-off information.

Submission to the laboratory through other hospital pathology departments

Many hospitals have a daily transport to the Birmingham Public Health Laboratory. Specimens for forwarding can be submitted to the following hospital pathology receptions for onward transport to the laboratory:

• Good Hope Hospital Pathology Reception
• Solihull Hospital Pathology Reception

Submissions to the laboratory through the post

Specimens can be submitted to the laboratory by post provided they are packaged according to current postal regulations. Details of postal packs are given in Appendix 4.

Obtaining more postal packs

Environmental health departments are provided with a supply of postal transport packs for these purposes. These packs contain the appropriate packaging materials, instructions for use and a postage-paid envelope to accompany the specimen (see Appendix 4).

Any specimens sent by post must comply with infectious substances transport regulations.

Further supplies of sample packs, request forms and specimen containers are available by contacting the Birmingham Public Health Laboratory. You can send email them at  birminghamlab@ukhsa.gov.uk

Submission to the laboratory using an agreed courier

In special circumstances, for example the nature or scale of the outbreak, the Head of Operations at the Birmingham Public Health Laboratory may, by agreement, organise courier transport, additional specimen containers and any other materials. To request courier services, email birminghamlab@ukhsa.gov.uk

Investigation of local outbreaks

Environmental health officers, HPTs and general practitioners can continue to refer specimens for investigation of individual cases of infection and small community outbreaks using their local NHS laboratories if this has been their practice.

If an outbreak control team is convened by the HPT then the specimens should be referred to the UKHSA laboratory, after discussion with a senior member of the UKHSA laboratory staff. Mechanisms for the continued investigation of the outbreak will then be agreed by the outbreak control team.

As soon as an outbreak is recognised (of whatever size) and the samples are to be submitted to the Birmingham Public Health Laboratory, the UKHSA laboratory will assign an outbreak number/identifier. This must be used to identify specimens associated with the outbreak or incident.

If an outbreak is identified initially by an environmental health department (EHD) or HPT the outbreak specimens must be referred to the UKHSA laboratory in Birmingham under an outbreak number/identifier if one has been allocated.

For specimens other than faeces; please contact the duty consultant microbiologist/virologist or public health services manager to arrange the provision of appropriate collection kits.

Note: food, water or environmental samples should be sent to the UKHSA’s FW&E microbiology laboratory.

You must continue to follow current protocols to maintain the integrity of the samples during transport unless notified otherwise (note: not all should be refrigerated).

Other communicable diseases

Less common infections may require different specimen types or have less distinct storage and transport needs. In such circumstances, please consult with Duty Consultant Microbiologist/Virologist before taking and submitting specimens.

Test turnaround times

To find information about approximate test turnaround times, call the laboratory on 0121 424 3111. You can also email birminghamlab@ukhsa.gov.uk.

For communication on high priority specimens or any concerns during regular working hours, please call the Duty Clinical Microbiologist/Virologist.

Reporting results

Results will be reported by electronic reporting facilities, where available. Hard copy printouts can also be produced, especially where electronic reporting is not possible, and distributed via established routes.

Electronic reporting facilities are available depending on the compatibility of computer systems. Urgent results will be telephoned or sent to a secure email address by agreement.

Appendices

Appendix 1: sample submission safety considerations

This information provides health and safety considerations when packaging and transporting specimens.

Appendix 2: request form for clinical public health samples only

A request form for clinical public health samples is available to download as a PDF. This can also be accessed by clicking on appendix to on the homepage for this manual.

Appendix 3: request form for clinical public health gastrointestinal samples only

A request form for clinical public health samples is available to download as a PDF. This can also be accessed by clicking on appendix to on the homepage for this manual.

Appendix 4: postal packaging for faecal samples

This information has images as guidance for packaging and posting faecal samples, along with instructions for Environmental Health Officers (EHOs) and patients sending enteric specimens.