Policy responses and statements

Page number

Item Number

Comments –
Royal College of Physicians of Edinburgh

4

Introduction

The Royal College of Physicians of Edinburgh welcomes the proposals set out in these guidelines as broadly appropriate for good clinical care and control of tuberculosis. The guidelines represent workable best practice that should already be in place in many routine NHS laboratories.

If they can be achieved nation wide, they will bring about an improvement in care and may in some cases result in reduced length of hospital stay. Once the standards are agreed it will be helpful for clinicians to be made aware of what they can expect from laboratories in this field.

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Para 3

1. Many laboratories will struggle to offer a 6 day service. It may be more reasonable, therefore, to specify that at least a 5-day service should be available. Out-of-hours smear testing may compromise quality, largely related to the way in which the specimen is processed.

2. Obviously the microscopy result should be released as soon as the investigation has been completed; however, as mentioned above, this may not always be possible within one working day in a small laboratory. It is important to distinguish between “acute” specimens (that do require urgent auramine staining, out of hours if necessary) and routine or follow-up specimens.

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Para 4

1. For smaller laboratories processing fewer specimens the financial outlay involved in introducing a liquid culture system may be unrealistic, meaning that specimens for mycobacterial investigations will need to be transferred to a nearby facility with the relevant technology and accreditation.

2. If liquid cultures are employed there is probably no reason why conventional solid cultures should be set up as it has been established that liquid cultures are quite adequate on their own.

3. Although a positive culture should be obtained within 21 days, it is common practice to incubate specimens for up to 6 weeks before declaring them culture negative.

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Para 4 (b)

Some laboratories may choose to do their own in-house geneprobe assays for preliminary identification of Mycobacterial cultures, although definitive identification should still rest with the appropriate Reference Laboratory.