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Microbiology Essentials

​Critical and Semi-Urgent Notification Values for Clinical Microbiology

Definitions

Critical Value

A value at such variance with normal (expected values) as to be life-threatening unless something is done promptly and for which some corrective action could be taken.

 

Designated health care provider notified by phone within 60 minutes of obtaining a critical value.

Designated health care providerRegistered Nurse (RN), Nurse Practioner (NP) or Most Responsible Physician (MRP)
​ICP​Infection Control Practitioner
Instant ReportPreliminary or Interim report status
​MOC​Microbiologist on call
MOC notification requiredMOC notified by phone within allotted time frame of obtaining a critical or semi-urgent value.
Outbreak

The occurrence of more cases of a particular infection or infectious disease than is normally expected the occurrence of an unusual organism, or the occurrence of unusual antibiotic resistance patterns.

 

These cases are identified with an Outbreak number which Public Health assigns to a specific outbreak for tracking purposes.

Semi-Urgent Value

A result or finding that does not pose an immediate health threat but could have near-term severe health consequences if not acknowledged and/or treated.

 

Designated health care provider notified by phone within 3 hours of obtaining a semi-urgent value.

STATImmediately
​TB Control
​Tuberculosis Prevention and Control


Critical and Semi-Urgent Values Notification Chart for Clinical Microbiology

TestSpecimen TypeNotifiable Critical ValueSemi- Urgent ValueMOC/ Doctor/ Ward/ ICP Notification Public Health Notification
Acanthamoeba PCR

Eye

 

PositiveYes Call MOC/ Doctor/ Ward 

Bacterial Culture (C&S)

​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​
  • Blood cultures   (only first bottle of each set assuming same gram morphology)
  • CSF
  • Corneal scraping
  • Sterile body sites
  • Surgical (OR)
  • Tissue

ALL bacteria isolated if Gram stain not previously reported with same gram morphology

 

Yes

 

 
  • Call Doctor/ Ward
  • Instant Report to Ward
 

Any specimen

​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​
Aeromonas hydrophila YesCall Doctor/Ward 
Bacillus anthracisYes 
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
  • Instant Report to ICP
  • Call
  • Instant and Final Report
Bacillus cereus   Instant and Final Report
Bartonella spp. Yes
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
 
Brucella spp.Yes 
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
Instant and Final Report
Burkholderia mallei/ pseudomalleiYes 
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
  • Instant Report to ICP
 
Campylobacter spp. YesCall Doctor/WardInstant and Final Report

Carbapenemase- producing enteric bacilli

  • New cases only
 

Yes

 

  • Call MOC
  • Call Doctor/ Ward/ ICP after lab consultation with MOC
  • Instant Report to ICP
Final Report 
Chlamydia psittaci   Instant and Final Report
Clostridium botulinumYes 
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
Instant and Final Report
Clostridium perfringenes   Instant and Final Report
Clostridium tetani   Instant and Final Report

Corynebacterium

  • diphtheriae
  • pseudo-tuberculosis
  • ulcerans
Yes 
  • Call MOC
  • Call Doctor/ Ward after lab consultation with MOC
  • Call after confirmed positive toxin testing
  • Instant and Final Report

Escherichia  coli

  • 0157:H7 (VTEC)

  • Enterohemorrhagic (EHEC)
  • Shiga-toxin (STEC)
  • Verocytotoxin
 YesCall Doctor/WardInstant and Final Report

Extended-spectrum beta-lactamase (ESBL) producing enteric bacilli

  • New cases only
 Yes
  • Call Doctor/ Ward/ ICP
  • Instant Report to ICP
Final Report 

Haemophilus influenzae   (serotypes a to f and non-typeable)

  • Invasive
Yes Call Doctor/WardInstant and Final Report
Francisella tularensisYes 
  • Call MOC
  • Doctor/Ward notified after lab consultation with MOC
  • Instant Report to ICP
Instant and Final Report
Klebsiella granulomatis   Final Report
Listeria monocytogenesYes Call MOC/ Doctor/ WardInstant and Final Report

Methicillin-resistant Staphylococcus aureus (MRSA)

  • New cases only
 Yes
  • Call Doctor/ Ward/ ICP
  • Instant Report to ICP
Final Report

Neisseria gonorrhoeae

  • Pediatric patients
  • Invasive
 

Yes

 

  • Call MOC    
  • Doctor/Ward notified after lab consultation with MOC

Instant and Final Report

 

 

Neisseria gonorrhoeae

  • Sexually transmitted infections
  

Call MOC

 

Instant and Final Report

 

 

Neisseria meningitidis

Yes

 

(CSF or Blood)

 

Yes

 

(Resp)

 

  • Call MOC (CSF or Blood  including Gram stain only)
  • Call Doctor/ Ward/ ICP
  • Instant Report to ICP

 

 

  • Call Positive Gram stain and Culture from all sterile body fluids (blood; CSF; joint; pleural, pericardial)
  • Call Positive Culture only on Respiratory (Resp) specimens
  • Instant and Final Report
Pleisiomonas shigelloides YesCall Doctor/WardInstant and Final Report

Salmonella

  • spp.
  • paratyphi
 Yes

Call Doctor/Ward

 

Instant and Final Report
Salmonella typhiYes 

Call MOC/ Doctor/ Ward

     

  • Call
  • Instant and Final Report
Shigella spp. Yes

Call Doctor/Ward

 

Instant and Final Report

Staphylococcus aureus

  • Invasive

 

   Final Report 

Staphylococcus aureus

  • Stools

 

 

   Instant and Final Report

Streptococcus agalactiae

  • Invasive (sterile sites only)
  Call Doctor/WardInstant and Final Report (Neonatal cases only)

Streptococcus pneumonia

  • Penicillin-resistant with MIC ≥ 0.12
  Call Doctor/Ward

Instant and Final Report

 

Streptococcus pneumonia

  • Invasive

Yes

 

 

Call Doctor/Ward

 

Instant and Final Report

 

Streptococcus pyogenes

  • Invasive
  
  • Call Doctor/ Ward/ ICP
  • Instant Report to ICP            
  • Call (Blood culture and known necrotizing fasciitis cases only)
  • Instant and Final Report

Vancomycin-resistant Enterococcus (VRE)

  • New cases only
 Yes
  • Call MOC (Blood cultures only)  
  • Call Doctor/ Ward/ ICP
  • Instant Report to ICP      
Final Report 

Vancomycin-intermediate Staphylococcus aureus (VISA)

  • New cases only
 Yes
  • Call MOC  
  • Doctor/ Ward/ ICP notified after lab consultation with MOC
  • Instant Report to ICP   
 

Vancomycin-resistant Staphylococcus aureus (VRSA)

  • New cases only
 Yes
  • Call MOC  
  • Doctor/ Ward/ ICP notified after lab consultation with MOC
  • Instant Report to ICP   
Final Report 
Vibrio choleraYes Call MOC/ Doctor/ Ward     
  • Call
  • Instant and Final Report
Vibrio species  Call Doctor/WardInstant and Final Report
Yerinia pestisYes 
  • Call MOC
  • Doctor/ Ward notified after lab consultation with MOC   
  • Call
  • Instant and Final Report

Yersinia

  • enterocolitica
  • pseudotuberculosis (Isolated from all clinical specimens)
 

Yes

 

Call Doctor/Ward

 

Instant and Final Report

 

Yersinia spp.  Call Doctor/Ward 
Bordetella pertussis/ parapertussis PCRNasopharyngealPositive Yes
  • Call Doctor/ Ward
  • Instant Report to ICP
Instant and Final Report
Clostridium difficile PCRFecesPositive Yes
  • Call Doctor/ Ward
  • Instant Report to ICP   
Instant and Final Report
Cryptococcal Antigen Detection
  • CSF
  • Serum
PositiveYes Call MOC/ Doctor/ Ward  
Cryptococcus spp.
  • BAL
  • CSF
  • Sterile body sites
PositiveYes Call MOC/ Doctor/ Ward      
Cytomegalovirus PCR CSFPositive YesCall Doctor/ Ward      

Enterovirus/  

Parechovirus PCR

 

CSFPositive YesCall Doctor/ Ward      

Epstein-Barr virus PCR

 

CSF

 

Positive YesCall Doctor/ Ward      

Fungal Culture

 

 

 

 

 

 

 

 

 

 

​ ​
  • BAL
  • CSF
  • Sterile body sites

All fungus isolated

 

Yes Call MOC        

Any specimen

 

 

 

 

 

 

  • Actinomycetes
  • Sporothrix schenckii
 Yes
  • Call MOC 
  • Call Doctor/ Ward after lab consultation with MOC    
 
  • Blastomyces dermatitidis
  • Coccidioides immitis
  • Histoplasma capsulatum
  • Paracoccidioides brasiliensis
  • Penicillium marneffei
  • Zygomycetes
Yes 
  • Call MOC  
  • Call Doctor/ Ward after lab consultation with MOC    
 

Fungal Smear

 

 

  • BAL or Bronchial washing (excluding yeast and pseudohyphae)
  • CSF
  • Sterile body sites
Fungal elements seenYes 
  • Call MOC
  • Doctor/ Ward called after lab consultation with MOC   
 

Gram Stain

 

 

​ ​ ​
  • Blood cultures
  • CSF
Gram negative cocciYes 
  • Call MOC/ Doctor/ Ward
  • Instant Report to Ward
  • Call
  • Instant and Final Report

Blood cultures

 

  • First positive bottle of first positive set (indicating new infection)
  • Different gram morphology from previous positive bottle/set
Yes 
  • Call Doctor/ Ward
  • Instant Report to Ward
 
  • Previous positive bottle/set (indicating same infection)
 YesInstant Report to Ward 
  • All STATS
  • Corneal scrapings
  • CSF
  • Respiratory (probable pathogen indicated)
  • Sputum or Tracheal secretions/aspirates with poor Q-score     (inpatients only)
  • Sterile body sites
  • Surgical/O.R. (sterile sites only)
  • Tissues (sterile sites only)
Positive Gram stains

Yes

 

 

 

 

 

 

 

 
  • Call Doctor/ Ward
  • Instant Report to Ward

 

 

 

 

 

 
Hantavirus

Serum

 

Positive   Instant and Final Report

Herpes Simplex virus PCR

 

 

  • Amniotic fluid
  • ANY specimen collected from neonate < 28 days
  • CSF
  • Ocular
Positive Type 1 or Type 2Yes 

Call MOC/ Doctor/ Ward

     

Instant and Final Report
HIV ​ ​All STAT serum ​All Negative testing resultsYes  Final Report
All Positive testing resultsYes Call MOC       Final Report
Routine SerumPositive or IndeterminateYes Call MOC       Final Report
Human T lymphotropic virus (HTLV) type 1SerumPositive   Final Report
JC virus PCR CSFPositive YesCall MOC/ Doctor/ Ward        
Legionella PCRRespiratory Positive Yes
  • Call MOC/ Doctor/ Ward
  • Instant Report to ICP (inpatients only)
Instant and Final Report
Measles virusSerumPositive   Instant and Final Report
Mumps virusSerumPositive   Instant and Final Report

Mycobacterium (AFB)

 

​ ​ ​
  • Blood
  • CSF
  • Sterile sites

All mycobacterium isolated

 

Yes 
  • Call MOC/Ward/ICP from Acute care wards/clinics
  • Call MOC/Doctor From Outpatients (outside Acute care)   

 


 

 

 

 



     
 TB Control - Instant and Final Report
     

Any specimen

​ ​
  • Mycobacterium tuberculosis complex
  • Drug-resistant Mycobacterium tuberculosis complex

Yes

 

 

 

 

 
  • Rapid growers
 Yes
  • Nontuberculous Mycobacteria (NTM)
 Yes

Norovirus PCR

 

 

 

 

 

 

 

Feces

 

 

 

 

 

 

 

Positive (Routine) Yes Instant and Final report

Outbreaks

  • Indicated by outbreak number

 

 

 

 

Yes 
  • Call MOC/ Doctor/ Ward (Positive reports only)  
  • Instant Report of ALL Negative and Positive results to Doctor/Ward/ICP

Instant and Final report on ALL Negative and Positive results

 

 

 

 

Ova and Parasite ​ ​ ​ ​ ​Non-intestinal sitesStrongyloides stercoralis larvaeYes Call MOC/ Doctor/ Ward   
From central nervous system (CNS)Acanthamoeba / Naegleria spp.Yes Call MOC        
Any specimen ​ ​ ​
  • Cryptosporidium spp.
  • Entamoeba  histolytica / dispar
  • Giardia lamblia
 YesCall Doctor/WardInstant and Final Report
  • Cyclospora cayetanensis
  Call Doctor/WardInstant and Final Report
  • Echinococcus
 YesCall Doctor/Ward 
  • Trichinella
   Instant and Final Report
Parvovirus B19SerumPositive (IgM only)   Final Report
Pneumocystis jiroveciiAny specimenPositiveYes 
  • Call MOC (New cases only)
  • Doctor/Ward called after lab consultation with MOC        
 
PoliovirusSerumPositive   
  • Call
  • Instant and Final Report
Respiratory PCR ​ ​
  • Bronchial
  • Nasopharyngeal
  • Throat
​ ​
Influenza A or B                
  • Call Doctor/ Ward
  • Instant Report to ICP
Instant and Final Report

Outbreak

  • Indicated by outbreak number
Yes 
  • Call MOC/Doctor/ Ward (Positive reports only)  
  • Instant Report of ALL Negative and Positive results to Doctor/Ward/ICP
Instant and Final Report on ALL Negative and Positive results
RSV  Instant Report to Ward and ICP 
Rickettsia spp. Positive   Instant and Final Report
Rubella virusSerum

Positive

  • Congenital syndrome
  • Other
   Instant and Final Report

SARS coronavirus (SARS-CoV)

 Positive   
  • Call
  • Instant and Final Report

Toxoplasma gondii

 

SerumPositive (IgM only)   Instant and Final Report

Varicella Zoster virus PCR

 

 

CSFPositiveYes 
  • Call MOC/ Doctor/ Ward
  • Instant Report to Ward and ICP
Final Report
Any specimenPositive  Instant Report to ICPFinal Report
Viral Serology

Serum

  • Transplant patients
All testing results Yes Call Doctor/Ward 
West Nile virus PCR ​

Serum

  • Transplant patients
PositiveYes Call Transplant CoordinatorInstant and Final Report
OtherPositiveYes 
  • Call Doctor/ Ward
  • Instant Report to Ward
Instant and Final Report




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Laboratory Controlled Document LSM-798 v1

Last Modified: Wednesday, February 3, 2016 |
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