Dear Kimrin Pannu

Thank you for your request under the Freedom of Information Act.  The reference for this request is noted in the subject header above.

You will receive a response from us within 20 working days of receipt or an explanation as to why this is not possible. 

Yours sincerely

Freedom of Information Team
Royal Free London NHS Foundation Trust

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  [1]http://freenet/docs/Comms/Toolkit/020%20...

Royal Free London Group Headquarters

Anne Bryans House

77 Fleet Road

London NW3 2QH

                                                                                                                                                                                                                                            
                               
                                                                                                                                                                                                                                                                                         

 

Dear Kimrin Pannu

 

Thank you for submitting a request for information under the Freedom of
Information Act 2000.  Please find the response below.  This response
covers the hospitals and services managed by the Royal Free London NHS
Foundation Trust, namely the Royal Free Hospital, Barnet Hospital and
Chase Farm Hospital and associated group services.  

 

The response

Questions for clinical team(s):

 

1.    Of the following, which guidelines does your Trust follow for the
diagnosis and treatment of meningitis/encephalitis: (Please answer:
Yes/No)

 a. NICE Guidelines (CG102) - Bacterial meningitis in under 16s:
recognition, diagnosis and management

Yes

 

 b. UK Joint Specialist Societies guideline on the diagnosis and
management of acute meningitis and meningococcal sepsis in
immunocompetent adults (published 2016) 

Yes

 

 c. Association of British Neurologists and British Infection Association
National Guidelines – Management of suspected viral encephalitis in
adults (published 2011) 

Yes

 

 d. Association of British Neurologists and British Paediatric Allergy,
Immunology and Infection Group National Guidelines – Management of
suspected viral encephalitis in children (published 2011)

No

 

 2. Does your Trust have any locally developed/adapted guidelines for the
diagnosis and treatment of meningitis/encephalitis in both adults and
paediatric patients?

 a. If yes, please state which guidelines have been adapted and please
provide a copy of your local guidelines.

Please see attached.

• Redactions in black: Names of individuals have been redacted from the
document as this information constitutes personal data and is
therefore exempt under Freedom of Information Act 2000 Section 40(2)
(Personal Information).
• Redactions in blue: Bleep numbers have been redacted as the trust
considers this information exempt under Freedom of Information Act
2000 Section 38(1a) (Health and Safety). Information released under
FOI is considered as release to the ‘world at large’ rather than just
to you, as the individual applicant. The trust believes that releasing
bleep numbers into the public domain would endanger patient safety.

 

 3. What are the top 3 roles in your Trust, in order of involvement, that
are responsible for the development of local pathways and guidelines
for meningitis/encephalitis? 

Consultants in Medicine specialities, Consultants in Neurology,
Consultants in Infection specialties - Infection and immunity, infectious
diseases, microbiology and virology.

 

 

 4. Does your Trust typically take samples of blood cultures from patients
with suspected meningitis/encephalitis within: (Please select answer)

·                  1 hour of admission? 

·                  2-4 hours of admission?

·                  4-8 hours of admission?

·                  8> hours of admission?

 

 5. Does your Trust consistently carry out lumbar punctures in patients
with no contradictions who have suspected meningitis/encephalitis?
(Yes/No)

 a. If yes, who performs the lumbar puncture? (Please specify job role)

Doctors appropriately trained to perform lumbar punctures in Medicine,
Neurology and Infectious diseases.

 

 6. Does your Trust consistently take cerebrospinal fluid (CSF) samples
via lumbar puncture from patients with suspected
meningitis/encephalitis within: (Please select answer)

• 1 hour of admission?
• 1-2 hours of admission?
• 2-4 hours of admission?
• 4-8 hours of admission?
• 8-12 hours of admission?
• >12 hours of admission?

This answer will vary depending on when the patient has been referred. 
Ideally if safe for the patient, then a LP would be considered.  

 

 7. Does your Trust administer antibiotics to patients where appropriate
prior to taking blood culture and CSF samples? (Yes/No)

This will depend on the clinical presentation.  Ideally blood cultures and
CSF samples should be taken first, but if the patient is critically unwell
then antibiotic should NOT be delayed.

 

 8. Does your Trust consistently administer antibiotics to patients with
suspected meningitis/encephalitis within: (Please select answer)

·                  1 hours of admission?

·                  2-4 hours of admission?

·                  4-8 hours of admission?

·                  8> hours of admission?

 

The answer to this question will depend on the clinical presentation.

 

Questions for lab team(s):

 9. Which of the following guidelines does your Trust follow for the
microbiological investigation of meningitis/encephalitis: (Please
select: Yes/No)

a.    UK Standards for Microbiology Investigations – Meningoencepahilits
(published 2014)

Yes

b.    UK Standards for Microbiology Investigations – Investigation of
Cerebrospinal Fluid (published 2017)

Depends on clinical details provided and clinical discussions. 

 

10. Does your Trust have any local adaptations or amendments to the two UK
Standards for Microbiology Investigations listed in the above
question?

No (Micro)

Virology - CSF Parechovirus PCR undertaken routinely in all patients
rather than limited only to children aged less than 3 years

 

a.    If yes, please provide a copy of your local amendments.

Not applicable

 

11. Following lumbar puncture on a patient with suspected
meningitis/encephalitis, how long are the turnaround times from point
of receiving specimen to result on the following tests: (Please select
answer for each result)

 a. Cell count (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

2-4hrs

 b. Gram staining (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

2-4hrs

 c. Bacterial culture (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

>4hrs

 d. PCR (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

>4hrs

12. Where does your Trust process CSF samples?

Health Services Laboratory (HSL)

Virology - HSL, except for following tests sent to other reference
laboratories:

·         HHV6 PCR 

·         Mumps PCR, Rubella PCR

·         Flaviviridae and other imported pathogens 

 

13. Does your Trust perform PCR testing to test samples from patients with
suspected meningitis/encephalitis? (Yes/No)

Yes, Virology PCR testing is routine.  Microbiology PCR testing is
performed on request by clinical microbiologist depending on clinical
details and whether rapid PCR result would be beneficial.

 

14. If PCR testing is carried out in your Trust, which bacterial and viral
pathogens are tested for? (Please separate your answer by bacterial
and viral pathogens)

Microbiology PCR:

1.    Multiplex PCR containing targets for:

·         Neisseria meningitidis

·         Streptococcus pneumoniae

·         Haemophilus influenzae

·         Streptococcus agalactiae (Group B Streptococcus)

·         Listeria monocytogenes

·         E coli K1

·         Mycoplasma pneumoniae

·         Cryptococcus neoformans / gattii

2.    TB PCR and 16s PCR can also be done if required / clinically
indicated.

Virology PCR:

Routine CSF panel:

·         HSV 1 DNA

·         HSV 2 DNA

·         VZV DNA

·         Enterovirus RNA

·         Parechovirus RNA

·          

Additional testing in immunocompromised patients:

·         CMV DNA

·         EBV DNA

·         HHV 6 DNA 

·         JC virus DNA

Other testing where clinically indicated:

·         Measles PCR

·         Mumps PCR

·         Rubella PCR

·         Flaviviridae and other travel associated pathogens PCR

 

Your appeal rights

 

I hope that this response deals with your enquiry to your satisfaction,
however if not you have two options:

 

·         If you do not feel that we have provided you with the
information you requested, you may contact us again and state what
information you still require.  However if you ask for additional and/or
different information this will be dealt with as a new request.

 

·         All applicants have the right of appeal and can request an
internal review.  The internal review must be focused on the original
request and should identify how the trust’s response failed to answer your
information request and explain what you would like us to review.  Appeals
should be made in writing, within 40 working days of the date of the
response, and addressed to Mr Kevin Winter, Associate Director of
Information Governance, Royal Free London NHS Foundation Trust at
[2][Royal Free London NHS Foundation Trust request email] .

 

If you are not satisfied with the internal review, you can appeal to the
Information Commissioner.  The contact details are: Information
Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9
5AF, telephone 01625 545 700 or see [3]www.ico.org.uk

 

Open Government Licence

 

The trust allows you to reuse this information under the Open Government
Licence found at the following [4]link. 

 

Yours sincerely

 

Freedom of Information Team

Royal Free London NHS Foundation Trust
Anne Bryans House

77 Fleet Road, London, NW3 2QH

 

[5]www.royalfree.nhs.uk
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