Section IV: Laboratory Management

2019 MOP –Foodborne and Waterborne Diseases Prevention and Control Program 1
Clinical Laboratory Role, Structure and Services
Peripheral Laboratory
Qualified Tertiary Laboratory: is a tertiary laboratory whose qualification for aerobic bacterial culture and identification for outbreak
specimens has been have been assessed by NEQAS for Bacteriology.

Qualified Regional Laboratory: is a regional laboratory whose qualification for aerobic bacterial culture and identification for outbreak
specimens has been have been assessed by NEQAS for Bacteriology.

Qualified Sub-national Laboratory: will be considered qualified if it meets the minimum requirements in the annual proficiency test
and if it passes other quality assurance checks by the National Reference Laboratory.

National Reference Laboratory: performs specialized diagnostic tests; provides confirmatory tests to tertiary, regional and sub-national
laboratories; provides referring laboratories transport media and guidelines on the use of such media; and banks positive outbreaks
nationwide

International Collaborating Centers and Referral Laboratories/ Regional Reference or Global Specialized Laboratories: refers to
laboratories that receive and test specimens from WHO region which are part of the international laboratory
2 network.
Clinical Laboratory Role, Structure and
Services
During FWBD outbreaks and other conditions of international concern when there is a need to urgently confirm
the diagnosis and to save the quality of the specimen, clinical specimens from the LGU are transported directly
to the National Reference Laboratory

Specimen Collection, Handling and Storage

Based on the clinical symptoms and data gathered, the initial impression will determine the possible etiologic
agent and the kind of specimen to be collected. Tables provide a summary guide for specimen collection for
specific illness that are currently under surveillance. There are general guidelines on specimen collection to
ensure the integrity of the specimen

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Summary Guide For Specimen Collection
Disease Tests Appro- Time of Quantity Container/ Storage Condition Transport/ Time Turn-
priate Collection Transport Medium Prior to Transport conditions around
Speci- Time
men
Cholera Culture Fresh As soon as 2-5 ml liquid or 5 Clean, dry, wide 4 degrees Celsius up Cold Pack within 3-6 3-5 days
; *Confirma- stool possible grams solid mouthed, leak- to 24 hours hours (within 24
Shigella after onset proof container hours)
tory
spp. of illness
preferably
during or Cary Blair at room
active Room temperature
or Cary Blair temperature
diarrhea within 24 hours

Rectal 1-2 swabs Cary Blair Transport Room temperature Room temperature
swab Medium in screw- up to 24 hours or 4 degrees Celsius/
capped tube within 3-5 days

Cholera Rapid Diagnostic Test (RDT)- screening only

Summary Guide For Specimen Collection
Disease Etiologic Tests Appropriate Time of Quantity Container/ Storage Transport/ Is the test Turn- Testing
Agent Specimen Collection Transport Condition Time Confirmatory/ around Centers
Medium Prior to conditions Rapid/ Time
Transport Presumptive
Test

Typhoid Salmonella Stool Fresh stool 2nd to 3rd 5 grams Clean, dry, Room Confirmatory Minimum RITM or
typhi Culture week wide temperature of 5 days any
solid In a holding
after mouthed, within 1-2 qualified
medium at
onset of leak-proof hours tertiary
room
Salmonella illness container laboratory
temperature
Paratyphi or Cary
or 4 degrees
A Blair
Celsius for
up to 24
hours Cold packs
Salmonella within 3-6
spp. hours

4 degrees
Celsius
within 24
hours

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Summary Guide For Specimen Collection
Disease Etiologic Tests Appropriate Time of Quantity Container/ Storage Condition Transport/ Time
Is the test Turn- Testing
Agent Specimen Collection Transport Prior to Transport conditions Confirmatory/ around Centers
Medium Rapid/ Time
Presumptive
Test
Typhoid Salmonella Culture Rectal swab 2nd to 3rd 2 swabs Cary Blair Room temperature Room temperature Confirmatory 3-5 days RITM or
typhi week after Transport up to 24 hours or 4 degrees any
onset of Medium in Centigrade/within qualified
illness screw capped a week tertiary
Salmonella tube laboratory
Paratyphi A
Blood 1st week after Adult: Blood Incubate at 35-37 Room 7 days
onset of Culture Broth Degrees Celsius or temperature/
Salmonella illness 1:5 to 1:10 store at room within 3 after
spp. ratio with temperature until collection
BCB ready for transport

Infant/Child:
1:10 to 1:20
ratio with
BCB
Sero- Pure isolate Nutrient Agar Refrigerated Room temperature Confirmatory Minimum
grouping/ butt/ slant in temperature as soon as possible 5 days
Sero-typing disposable
plastic leak-
proof tube

6
Summary Guide For Specimen Collection
Disease Etiologic Tests Appropriate Time of Quantity Container/ Storage Transport/ Is the test Turn- Testing
Agent Specimen Collection Transport Condition Time Confirmatory/ around Centers
Medium Prior to conditions Rapid/ Time
Transport Presumptive
Test

Acute Rotavirus ELISA Stool Upon first 5-10 ml Sterile leak- Refrigerated In ice within Presumptive 5-7 days RITM
Watery contact proof screw prior to 72 hours
Diarrhea with the capped transport
patient type
container

Hepatitis Hepatitis HAV Serum 1 Onset of At least 1- Screw 4 degrees In ice Presumptive 24 hours
A IgM sample only illness 2 ml capped Centigrade
cryotube Celsius

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Laboratory examination
 Kato Katz Method – recommended method
41.7mg stool sample
 Kato Thick Method
 No template
 Direct Fecal Smear- loose/watery stool
2 mg stool sample
Cyst and trophozoites

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GENERAL CONSIDERATION
Number and types of specimens
 Helminth eggs, passed on continual basis
 Protozoans, passed intermittently, multiple specimens collected at
2 -3 days interval
 Eggs of Schistosoma, Heterophyid, Capillaria, Taenia

Time factor in examination

 Watery, liquid, diarrheic specimens: within 30 minutes.
 Formed specimens: >1 hr, or within the day
• If not possible can be preserved in a fixative such as Polyvinyl
Alcohol (PVA) or Merthiolate-Iodine-Formaldehyde (MIF) .
• It maybe refrigerated (4 – 5 °C) until the next day
Figure 8: Flow of Laboratory Information from the Testing Laboratory to the Referring Institution

Laboratory Testing Facility

Official Laboratory Result:

Linelist Individual Result

WHO Country and

Regional Office EB RESU
IHR Focal Point Office

CESU/PESU/MESU Referring Institution/ DRU/ESU

Local Outbreak Response

Patient Care Management

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National Outbreak Response

Flow of Laboratory
Referral From Collection
to Receipt at Testing
Laboratory

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Any questions?
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