Test Updates
Changes in Virology Testing
On Nov. 1, 2011, the Microbiology Laboratory will initiate significant changes in the way GHS clinicians order virology testing in EPIC. Prior to Nov. 1, a clinician needed only to order VIROS (viral studies) and the appropriate test would be performed (protocol driven by the source, age of the patient, GHS standards of Care and the time of the year [respiratory virus protocols]). With a growing number of molecular virology tests (and more in the pipeline), as well as additional test options, we need to change to test specific ordering.
This change will apply to all of the virology testing (molecular as well as the remaining viral cultures) performed in the microbiology laboratory.
Nine (9) test specific order codes will be utilized at this time, by all providers, including GHS:
Respiratory Virus PCR Testing
1. Influenza A&B and RSV PCR (PCRABR)
- Includes testing for Influenza A&B and RSV.
- PCRABR includes a rapid antigen test for RSV for patients ≤ 5 y.o.
If the RSV rapid antigen test is positive, the PCR ABR will not routinely
be performed.
- PCRABR is only performed Nov. 1-April 30 (Influenza and
RSV season).
- PCRABR is the recommended test for all GHS outpatients.
- PCRABR is not offered for inpatients. Order RVPCR for inpatients or if suspecting other respiratory viruses.
2. Respiratory Viral Panel PCR (RVPCR)
- Includes testing for Influenza A (H1, H3 and non-typeable), Influenza B, RSV A and B, Adenovirus, Parainfluenza Virus types 1-3, Rhinovirus, and Human Metapneumovirus.
- From Nov.1-April 30, RVPCR includes a rapid antigen test for RSV for patients ≤ 5 y.o. The RVPCR assay will be performed regardless of the rapid RSV result.
- RVPCR is the approved assay for all GHS inpatients.
- Do not order PCRABR on GHS inpatients.
For ER patients, order RVPCR if the patient is being admitted. For ER patients who are not being admitted, you may order PCRABR or RVPCR but not both.
Importantly, you cannot order PCRABR and RVPCR on the same specimen.
Herpes Virus Family PCR Testing
3. Herpes Simplex 1&2 and Varicella Zoster Virus PCR (PCRHVZ)
- GHS standard of care for all dermatological (skin) specimens.
- When ordering this test, do not order the individual tests for HSV (PCRHSV) or VZV (PCRVZV).
4. Herpes Simplex 1&2 PCR (PCRHSV)
- Order for CSF specimens and non-dermatological specimens collected with a swab/UTM (e.g. oral, genital, rectal, and eye specimens).
- For dermatological (skin) specimens, always order HSV/VZV PCR (PCRHVZ) instead of PCRHSV.
- Varicella Zoster PCR (PCRVZV)
- Order for non-dermatological specimens collected with a swab/UTM (e.g., eye specimens).
- For dermatological (skin) specimens, always order HSV/VZV PCR (PCRHVZ) instead of PCRVZV.
Viral Culture Testing
6. Varicella Zoster Viral Culture (VZVVC)
- Order for non-dermatological specimens not normally collected with a swab.
7. Herpes Simplex 1&2 Viral Culture (HSVVC)
- Order for non-CSF and for specimens not normally collected with a swab.
8. Cytomegalovirus Viral Culture (CMVVC)
- Order for all specimen types.
- Enterovirus Viral Culture (EVVC)
- Order for all specimen types.
Discontinued Tests
Viral Studies (VIROS -- previously available only to GHS providers)
- This test will no longer be offered as of Nov. 1.
Future Direction
We plan in the future to migrate some of the remaining viral culture tests listed above to PCR assays. It requires considerable effort and time to validate the molecular assays as most are not FDA cleared; hence the need to progressively migrate the assays/specimen types over time.
Recent changes in reference ranges or alert limits:
The following changes took effect October 17:
Urine albumin:
Normal: 0-29 mg/24 hours
High: 30-300 mg/24 hours
Very High and Nephrotic: >(greater than) 300 mg/24 hours
Microalbumin Creatinine Ratio (MICALB):
Albumin - random urine: 0-2 mg/dL.
Creatinine - urine: Undefined.
Microalbumin ratio:
Normal: 0-29 mg/g creatinine
High: 30-300 mg/g creatinine
Very High and Nephrotic: >(greater than) 300 mg/g creatinine
Fasting Plasma Glucose (GLUFP):
Based on guidelines from American Diabetes Association:
Fasting glucose < 100 mg/dL ~ normal
100 mg/dL <= fasting glucose < 126 mg/dL ~ pre-diabetes
fasting glucose >= 126 mg/dL ~ diabetes, confirmed by repeat testing on a different day.
Alert limits: Below 40 mg/dL, above 200 mg/dL.
