Events on 27 September 2023

To explore the molecular profiles of Acanthamoeba from laboratory-confirmed Acanthamoeba keratitis (AK) cases reported within the United Kingdom (UK) using DNA taken directly from clinical samples.

Acanthamoeba species are free-living organisms responsible for causing a debilitating, sight-threatening disease of the cornea. Of the 24 known Acanthamoeba species, 14 cause AK.

Thirty-five Acanthamoeba DNA-positive corneal samples from the Scottish Microbiology Reference Laboratories (SMiRL), Glasgow collection were selected from cases reported from 2017 - 2019. Following extraction of the DNA directly from each clinical specimen, the DNA was subjected to in-depth molecular typing using a nested PCR / bi-directional sequencing approach.

Molecular profiling was successful for 32 samples which comprised of two genotypes namely T3 and T4. The T4 genotype were further sub-typed; five sub-types existed namely; T4A, T4B, T4C, T4E and T4F.

Using a molecular typing assay applied directly to corneal tissue, this study highlights the T4 genotype and the T4A subtype are the predominant molecular variants of Acanthamoeba to cause ocular disease in the UK. Gaining in-depth information on the molecular profiling of Acanthamoeba is essential to increase our knowledge and understanding of the epidemiology, transmission pathways and potential associations with clinical outcomes for this rare, yet potentially debilitating ocular disease.

Antimicrobial resistance (AMR) in anaerobic bacteria varies greatly between institutions and countries. It is crucial that we have robust and widely available methods and perform regular surveillance to raise awareness of AMR amongst laboratory and clinical teams.

The UKARU offers a UK-wide service for the identification and antimicrobial susceptibility testing (AST) of anaerobic clinical isolates. Since 2016, this service has included weekly AST by agar dilution. The MIC population distributions for isolates referred are presented in real time via the ARUMIC platform, facilitating continuous monitoring of the development of resistance and valuable data for the review and development of epidemiological cut-offs (ECOFFs) and species-specific breakpoints, alongside the European Committee for Antimicrobial Susceptibility Testing (EUCAST).

During 2017 – 2021 EUCAST and the UKARU reviewed the AST methodology and breakpoints for anaerobes and developed a standardised disk diffusion method. Fastidious Anaerobe Agar with horse blood (FAA-HB) was used to test the most commonly isolated anaerobic bacteria including Bacteroides spp (n=170), Prevotella spp. (n=49), Fusobacterium necrophorum (n=51), Clostridium perfringens (n=58) and Cutibacterium acnes(n=54). The antimicrobials included for the initial phase were benzylpenicillin, piperacillin-tazobactam, meropenem, metronidazole and clindamycin with vancomycin included for the Gram positive organisms. Breakpoints for additional agents have just been published on the EUCAST website.

This lecture will provide insights into the development of AMR in anaerobic bacteria, the available AST methodologies and the importance of surveillance for this important group of pathogens.

Many of us have diagnosed, treated or researched Clostridiodes difficile infection (CDI) for many years and probably know the organism and the disease it produces very well indeed. But how well do we really know it? In truth, we only know this from our own perspective. What is it really like to suffer from CDI? How well do the pathways and guidance we contribute to function in the experience patients?

This talk will focus on patient experiences of CDI, what they can teach us as clinicians and researchers and why involving patients and the public in designing our research and clinical services can help everyone.

Understanding your laboratories baseline data is the most important first step to identify where to improve services. Data is key to understanding preanalytical processes, simple things such as the location of phlebotomy clinics, the timings of transport collections, the number of paper requests all have an impact on specimen reception workflows and specimen turnaround times.

Many labs still continue to measure a specimen's turnaround time from the moment it arrives at the lab, which is too late.

We will demonstrate how data modelling and innovative transport solutions will improve system workflows, reduce specimen rejections, smooth out specimen arrivals, reduce the output of CO2 and meet the preanalytical quality requirements for your next UKAS inspection.

Blood Transfusion follows binary guidelines designed to protect against the formation of allo red cell antibodies capable of causing Haemolytic Disease of the Foetus and Newborn. For the first time, in 2021, the England and Wales Census included a gender identity question, ‘Is the gender you identify with the same as your sex registered at birth?’. 0.5% of respondents answered ‘No’ (262 000 people) of which 48 000 identified as a trans man, 30 000 as non-binary and 18 000 as another gender identity. Thus, there is a small, but significant, population of Transgender and Gender Diverse (TGD) individuals in society.

What are the implications for Blood Transfusion? There are several scenarios:

The lab could receive a sample labelled male and issue blood components which fail to meet the requirements of Kell negative and, if applicable, CDE negative red cells to someone with childbearing potential.

The lab could receive an antenatal sample labelled male and the LIMS does not allow staff to perform all the same testing and product issuing as it would for a female.

Some TGD individuals who have transitioned may get a new NHS number. Lab staff may be unaware and lab records are not merged which means all future transfusion requests are relying solely on antibody screening results with no historical transfusion information.

The clinical consequences of these errors are missed incompatibilities, special requirements not met (SRNM) errors and immediate or delayed transfusion reactions with a potential for major morbidity or mortality.?All the circumstances described above illustrate that provision of healthcare is not uniform?for?all patients in the UK and could be described as indirect discrimination - a policy or practice that is identical for all people but has an unfair or disproportionate effect on a people with a protected characteristic.

HR and OH departments – how to work with them to achieve the best results

Managing change with compassion

The debate about performance and sustainability of our healthcare services is often reduced to a questions of money and beds are there enough of either? Both are back ups to the more important question - are there enough staff?

The size and complexity of the workforce challenge means there will need to be concerted and sustained action across the system on workforce planning, training, retention, productivity, job roles and creating workplace cultures - that demonstrates staff are valued. For our sector, action is needed both in the short term and the long term to support the workforce and meet the needs of our service and how this will meet the wider healthcare service for patients.

This presentation will look at how leaders at all levels need to work collectively to address our workforce challenge and how we can together take action at a local, regional and national level.

Generation X,Y,Z: Ageism in the workplace and its impact on service delivery

Problems can happen when we least expect them. Loss of a key building, a cyber-attack or a system failure, interruption to a utility supply, severe weather, critical equipment failure, supply chain disruption or even a significant loss of staff. Sooner or later every organization will need to deal with issues like these and if there's no plan the outcomes could be far worse than they need to be. This is why services must maintain a critical incident response plan and a wide range of business continuity plans, having a structured approach for managing these unplanned disruptions.

Business continuity planning is just one part of a much bigger risk management process. We prepare for emergencies, not just because we're legally required to do so, but because patients, donors, and the wider NHS rely on our services being available every day.

There are four main scenarios all good business continuity plans should consider:

Loss of staff
Loss of the workplace
Loss of equipment and consumables and
Loss of ICT systems
The process should be one of a cycle of preparedness including

Risk Management or identification
Planning
Training
Exercising
Lessons identified