Effective May 9th, 2022, Spectrum Health Laboratory’s Microbiology Department will no longer be preemptively setting up cultures on swabs without a source and order, when received on Thursdays through Sundays and Holidays. Note: The specimen will still be held, but cultures will not be set up in anticipation of the order.
West Michigan influenza infections peaked mid-March 2022 and have been declining in the weeks that followed. Now with a low prevalence of circulating influenza, using the most sensitive diagnostic test is recommended in order to obtain accurate and actionable results. Influenza antigen testing (e.g. Sofia instrument) is no longer appropriate at this time and Influenza PCR testing should be ordered when clinically indicated.
|Recommended Order||Influenza PCR (LAB3255)||Influenza Rapid Antigen (LAB2111530)
Influenza PCR (LAB3255)
More detailed information can be found as published by the CDC:
Algorithm to assist in the interpretation of influenza testing results and clinical decision-making during periods when influenza viruses are NOT circulating in the community, and in previous lab newsletters: Influenza Diagnosis and Test Utilization
|Test name||Epic code||Interface EMR Code||CPT Code|
|Influenza Rapid Antigen||LAB2111530||11208||87804 x4|
As of April 12, 2022, Spectrum Health Laboratory will no longer add microbiology cultures to placental tissues received based on paper requisition forms.
Viral and bacterial cultures from placental tissue are rarely clinically beneficial and are no longer the gold standard diagnostic approach due to the relative insensitivity of culture methods.
If viral studies are desired (possible indications could include known CMV exposure with positive IgM or intrauterine fetal demise at < 28 weeks), then molecular testing is the recommended diagnostic approach. HSV and CMV PCR tests may be ordered in Epic.
Bacterial cultures are challenging to interpret since they typically grow normal genital flora and histopathological analysis used to diagnose acute chorioamnionitis correlates poorly with growth from bacterial placenta cultures. If indicated, culture and PCR tests may be ordered in Epic.
Placenta tissues sent to the lab in formalin are not acceptable for PCR or culture orders.
As of April 5th, 2022, Herpes Simplex viral PCR testing will transition from being performed in the Spectrum Health Molecular department to the Microbiology department. There are no changes to the acceptable specimen sources for this test (cerebrospinal fluid and blood plasma specimens). Benefits of the new Microbiology testing method include:
• The new test method (DiaSorin Simplexa® HSV PCR) is FDA-cleared for testing spinal fluid specimens with a validated modification for testing plasma specimens. The prior method was a lab-developed test for both specimen types.
• Especially for pediatric patients, collecting sufficient specimen volumes can sometimes be challenging. The new method requires a minimum of 0.05 mL specimen per run whereas the prior method required 0.2 mL specimen.
• The frequency of testing will increase from typically one run per day to testing being performed at several times each day.
Effective February 10, 2022, Spectrum Health Regional Laboratory will offer Varicella Zoster Virus (VZV) PCR testing on swab specimens collected from cutaneous and mucocutaneous lesions (e.g. anorectal, genital, nasal, ocular, oral, skin, urethral).
PCR is the test method of choice for the diagnosis of VZV infection due to its enhanced sensitivity and speed as compared to traditional viral cultures, which should no longer be used for VZV detection.
The following NEW items are available at the Spectrum Health Distribution Center.
ITM-1140078 – Viral Transport Media with Nasopharyngeal Swab (NP, UTM)
ITM-1186125 – Viral Transport Media with Flocked Swab (UTM)
ITM-1140078 has replaced ITM-1140814 – Saline Swab Kit for Covid Nasopharyngeal collection. ITM-1186125 is recommended for Nares (Nostril) collection. Please reference the Laboratory Catalog for more information on specimen collection containers for COVID testing.
The mitigation strategies enacted during the COVID-19 pandemic to reduce the spread of this virus led to essentially non-existent influenza prevalence during the 2020-2021 winter season. However, influenza has now returned and case numbers are increasing throughout West Michigan.
Influenza prevalence guides the most appropriate testing approach and sufficient prevalence has now been reached for influenza rapid antigen testing (e.g. Sofia instrument) to have improved performance. The use of rapid antigen testing as a screening method during high prevalence reduces both the cost to the patient and turn-around-time as compared to lab-based molecular methods. Rapid antigen tests generally have high analytical specificity, but lack the sensitivity of nucleic acid amplification methods (e.g. PCR). For this reason, PCR testing is still recommended for hospitalized patients and for outpatients with a negative antigen result if influenza is still suspected and if the result will impact clinical decision making.
The supply of the Sofia Strep Test Kits (ITM-1052057) has returned to a stable level allowing the system to migrate back to this Strep Test kit solely. Please note once the remaining supply of the alternative strep test kit (Cardinal – ITM-1157857) is depleted, the item will be inactivated.
Due to this change, please ensure competencies are up to date for the Sofia Strep test kit.
Procedure Reference #17340, #24118.
Spectrum Health Lab has noticed an increase in outpatient orders for Respiratory Pathogens by Film Array [LAB3359]. This may be due to a shortage of supplies for some Point of Care (POC) testing platforms. Film Array is typically used for emergency and high acuity patients and therefore has a high cost that may not be covered by most patients’ insurance. To lesson out of pocket costs for your patients, please order the below for RSV, COVID, or Flu testing.