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Improving Laboratory Diagnosis of Influenza and Respiratory Syncytial Virus Infections

Project Added:
19 September 2016
Last updated:
4 October 2016

Improving Laboratory Diagnosis of Influenza and Respiratory Syncytial Virus Infections

Summary

By introducing the routine use of rapid Nucleic Acid Amplification Tests (NAAT) at the South Eastern Area Laboratory Services (SEALS) Wollongong laboratory, the median time for results of accurate laboratory tests for influenza and Respiratory Syncytial Virus (RSV) infections reduced from more than three days to less than 12 hours. This has the potential to significantly enhance infection prevention and control, inpatient bed management, appropriate antiviral prescribing and antimicrobial stewardship initiatives.

Aim

To provide results of the most accurate laboratory tests for influenza and RSV infections to clinicians, within 24 hours of sample collection.

Benefits

Timely and accurate influenza and RSV laboratory test results are important for:

  • prescribing appropriate influenza antiviral therapy
  • implementing recommended infection prevention and control measures in the hospital setting
  • managing inpatient beds in the context of recommended infection prevention and control measures
  • reducing inappropriate antibiotic use through antimicrobial stewardship initiatives.

Background

Prior to implementation of the project, NAAT for influenza and RSV on swabs from patients at Illawarra Shoalhaven Local Health District (ISLHD) facilities were performed at the SEALS virology laboratory at Prince of Wales Hospital (POWH), using a multiplex Polymerase Chain Reaction (PCR) assay that targets 16 respiratory viruses.

Routine monitoring revealed that it often took more than three days for the results to be available to ISLHD clinicians. Rapid tests for influenza and RSV available at the on-site SEALS Wollongong laboratory were restricted to point-of-care antigen tests, which offered results within eight hours. However, these tests lacked diagnostic sensitivity (32-47% for influenza, 60% for RSV). This meant that samples still needed to be sent to POWH for a more accurate NAAT.

Swab samples undergoing rapid antigen tests required a second set of swabs to be collected and sent to POWH for NAAT. Feedback from ISLHD clinicians confirmed that the poor sensitivity of rapid influenza and RSV tests, in addition to the prolonged waiting time for NAAT results, caused:

  • missed infection prevention and control opportunities
  • problems for bed management
  • missed opportunities for influenza antiviral therapy
  • missed antimicrobial stewardship opportunities.

Implementation

  • A rapid Therapeutic Goods Administration (TGA) listed PCR assay for influenza A, influenza B and RSV was introduced for routine use at SEALS Wollongong.
  • Tests were performed between 8:00am and 11:30pm on weekdays, and 8:00am and 4:30pm on weekends and public holidays.
  • A modified respiratory virus testing algorithm was implemented at SEALS Wollongong.
  • All samples were screened with the rapid PCR assay for influenza A, influenza B and RSV at SEALS Wollongong.
  • Only paediatric samples that were negative for influenza A, influenza B and RSV, or samples with a specific request for any other respiratory virus, were sent to SEALS POWH for the multiplex PCR assay.
  • SEALS Wollongong discontinued the use of insensitive rapid antigen tests for influenza and RSV and replaced them with the more sensitive, rapid PCR assay for influenza A, influenza B and RSV. As a result, the second set of swabs no longer needed to be collected.

Project status

  • Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

  • August 2015 – October 2015

Implementation site

  • SEALS South, ISLHD

Parternships

  • ISLHD Infection Management and Control Service
  • ISLHD Antimicrobial Stewardship Program
  • Clinical Excellence Commission. Clinical Leadership Program

Results

  • Time for influenza and RSV NAAT results to become available, prior to the project:
    • mean: 81.3 hours
    • median: 73.3 hours
    • range: 38.1-145.5 hours
    • less than 12 hours: 0%
    • less than 24 hours: 0%
  • Time for influenza and RSV NAAT results to become available, post-implementation:
    • mean: 12.3 hours
    • median: 10.2 hours
    • range: 1.4-39.5 hours
    • less than 12 hours: 58.7%
    • less than 24 hours: 86.7%
  • Solutions were implemented using existing staff resources, with an estimated savings on consumables of around $9000 per year.

Lessons learnt

  • Centralising laboratory testing to a specialised laboratory is not always the most cost-efficient way of providing a customer-focused pathology service.
  • Centralising laboratory testing requires significant improvements to existing courier services and laboratory information systems.
  • Support and cooperation from staff and executive leaders is improved if there is robust baseline data that suggests clinical change is required.
  • Local stakeholder engagement is important, with consideration for keeping the project within its sphere of influence.

Further reading

Contact

Dr Peter Newton
Clinical Director of Microbiology
SEALS South, Wollongong Hospital
NSW Health Pathology
Phone: 0412 279 513
peter.newton1@health.nsw.gov.au

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