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Meningitis and Encephalitis Guidelines/Pathway

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Niklas Marksteiner

Dear FOI contact,

I am writing to request your assistance with an open government request according to the Freedom of Information Act 2000.

Please kindly complete the below questions.

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)
• NICE Guidelines (CG102) - Bacterial meningitis in under 16s: recognition, diagnosis and management
• UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults (published 2016)
• Association of British Neurologists and British Infection Association National Guidelines – Management of suspected viral encephalitis in adults (published 2011)
• Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines – Management of suspected viral encephalitis in children (published 2011)

2. Does your Trust have any locally developed/adapted guidelines for the diagnosis and treatment of meningitis/encephalitis in both adults and paediatric patients?
If yes, please state which guidelines have been adapted and please provide a copy of your local guidelines.

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?

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

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?

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

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?

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)
• UK Standards for Microbiology Investigations – Meningoencepahilits (published 2014)
• UK Standards for Microbiology Investigations – Investigation of Cerebrospinal Fluid (published 2017)

10. Does your Trust have any local adaptations or amendments to the two UK Standards for Microbiology Investigations listed in the above question?
If yes, please provide a copy of your local amendments.

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)
b) Gram staining (<1 hour, 1-2 hours, 2-4 hours or >4 hours)
c) Bacterial culture (<1 hour, 1-2 hours, 2-4 hours or >4 hours)
d) PCR (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

12. Where does your Trust process CSF samples?

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

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)

Thank you for taking the time to supply this information.

Yours faithfully,
Kimrin Pannu

swft@infreemation.co.uk, South Warwickshire NHS Foundation Trust

 
Information Governance
Warwick Hospital
Lakin Road
Warwick
CV34 5BW

Tel: 01926 495321
Email: [South Warwickshire NHS Foundation Trust request email]

Dear Niklas Marksteiner

We acknowledge receipt of your email to South Warwickshire NHS Foundation
Trust:

Freedom of Information request - Meningitis and Encephalitis
Guidelines/Pathway

If you have submitted a request under the Freedom of Information Act
(FOIA) or the Environmental Information Regulations (EIR), your request
will be considered and you will receive our response within the statutory
timescale of 20 working days.

The reference number for your email is FOI/1167.

Should you have any further inquiries concerning this matter, please reply
to this email leaving the subject line unchanged.

Yours sincerely,
South Warwickshire NHS Foundation Trust

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swft@infreemation.co.uk, South Warwickshire NHS Foundation Trust

3 Attachments

 
Information Governance
Warwick Hospital
Lakin Road
Warwick
CV34 5BW

Tel: 01926 495321
Email: [South Warwickshire NHS Foundation Trust request email]

Ref No:FOI/1167
 
Dear Niklas Marksteiner

 
Thank you for your request for Information under the Freedom of
Information Act.

Please see the response to your request below.

1. Of the following, which guidelines does your Trust follow for the
diagnosis and treatment of meningitis/encephalitis: (Please answer:
Yes/No)
• NICE Guidelines (CG102) - Bacterial meningitis in under 16s:
recognition, diagnosis and management - Yes
• UK Joint Specialist Societies guideline on the diagnosis and management
of acute meningitis and meningococcal sepsis in immunocompetent adults
(published 2016) - Yes
• Association of British Neurologists and British Infection Association
National Guidelines – Management of suspected viral encephalitis in adults
(published 2011) - Yes
• 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?
If yes, please state which guidelines have been adapted and please provide
a copy of your local guidelines.

Please see attached

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?

For adults: Consultant Medical Microbiologist, Consultant in Infectious
Diseases/Acute Medicine, Antimicrobial Pharmacist

For paediatrics: Consultant Medical Microbiologist, Consultant in
Paediatrics, Antimicrobial Pharmacist

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?

We aim to take blood cultures for any patient with suspected sepsis within
1 hour. If the patient is non suspected sepsis but meningitis/encephalitis
is still in the differential diagnosis blood cultures would normally be
taken in the first 2-4 hours of admission.

5. Does your Trust consistently carry out lumbar punctures in patients
with no contradictions who have suspected meningitis/encephalitis?
(Yes/No) - Yes
If yes, who performs the lumbar puncture? (Please specify job role) 

In adults- any competent medical professional (this could be a Consultant,
an ST doctor, a Foundation doctor (normally under supervision) or an
Advanced Clinical Practitioner.

In paediatrics (Yes), it is any competent
clinician,(SHO/Registrar/consultant)

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?

We do not hold this information, This is not straightforward to answer as
when a lumbar puncture is performed will depend on a number of factors
that will vary from patient to patient. This includes the clinical
presentation, severity of illness/stability of patient, the level of
suspicion of CNS infection, need for CT head before lumbar puncture, the
presence of any factors that might delay a lumbar puncture (e.g needing to
come off anticoagulation or requiring correction of abnormal clotting),
and availability of appropriately trained staff. This is essentially true
for paediatrics

7. Does your Trust administer antibiotics to patients where appropriate
prior to taking blood culture and CSF samples? -

In adults a stable patient with no signs of sepsis we would aim to obtain
blood and CSF cultures before administering IV Antibiotics. In a patient
with signs of or suspicion of sepsis or if there will be a delay of over 1
hour in obtaining lumbar puncture we would administer IV antibiotics
before LP.

In paediatrics we would usually collect the  samples for blood cultures
and CSF cultures prior to starting antibiotics, if patient is felt to be
unstable, antibiotics maybe given before the LP is done, usually the blood
cultures would have been taken.  when patient is deemed to be more stable,
the LP would be done.

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?

This would usually be within 1 hour of admission. In patients with no
signs of sepsis and in whom the suspicion of meningitis/encephalitis is
low at first presentation this may be 2-4 hours of admission.

In paediatrics we would administer the antibiotics within 1 hour of
admission.

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)
• UK Standards for Microbiology Investigations – Meningoencepahilits
(published 2014)  - Yes
• UK Standards for Microbiology Investigations – Investigation of
Cerebrospinal Fluid (published 2017) - Yes

10. Does your Trust have any local adaptations or amendments to the two UK
Standards for Microbiology Investigations listed in the above question?
If yes, please provide a copy of your local amendments. - Please see
below 

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)  - Please see below
a) Cell count (<1 hour, 1-2 hours, 2-4 hours or >4 hours)
b) Gram staining (<1 hour, 1-2 hours, 2-4 hours or >4 hours)
c) Bacterial culture (<1 hour, 1-2 hours, 2-4 hours or >4 hours)
d) PCR (<1 hour, 1-2 hours, 2-4 hours or >4 hours)

12. Where does your Trust process CSF samples? - Coventry and Warwickshire
Pathology Services (CWPS)

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

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) - Please see below

Coventry and Warwickshire Pathology Services (CWPS) is a managed network
of laboratories hosted by University Hospitals of Coventry and
Warwickshire NHS Trust.

Please refer Questions 10 , 11 and 14 to the following link

[1]Pathology - University Hospitals Coventry & Warwickshire (uhcw.nhs.uk)

If you are unhappy with the service you have received in relation to your
request and would like a review of our response please email
[email address], or write to Information Governance, Pickering's Building,
1st Floor, Warwick Hospital, Millers Road, Warwick, CV34 5AN
If you are not content with the outcome of your review, you may apply
directly to the Information Commissioner for a decision. Generally, the
ICO cannot make a decision unless you have exhausted the complaints
procedure provided by the South Warwickshire NHS Foundation Trust. The
Information Commissioner can be contacted at:
FOI/EIR Complaints Resolution
Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Or via their website www.ico.org.uk/contactus, or by telephone on 0303 123
1113

The Trust always seeks feedback on how it handles requests made under the
Freedom of Information Act. If you wish to provide feedback please e-mail;
[email address]

Kind regards

FOI Team

References

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We don't know whether the most recent response to this request contains information or not – if you are Niklas Marksteiner please sign in and let everyone know.