Effective September 1, 2009, influenza PCR testing at the University Hygienic Laboratory (UHL) will be limited to surveillance purposes and will not be used for diagnosing individual patients. The influenza tests available in the UIHC Microbiology Laboratory [influenza A/B antigen detection by direct fluorescent antibody (DFA) and respiratory virus culture] will detect novel influenza A (H1N1) as "influenza A." Testing may be ordered on EPIC using one of the following new panel:

• Influenza A/B Detection - This panel includes Influenza A/B antigen detection by DFA with reflex to culture if the DFA is negative.
• Respiratory Virus Detection - This panel includes antigen detection by DFA for influenza A/B, RSV, parainfluenza, and adenovirus with reflex to culture if the DFA is negative.
  
  

DFA results are provided the same day if specimen is received by 2:30 p.m. Respiratory virus culture results are available in 48 h. Requests for "H1N1" or "swine flu" PCR will be interpreted as a request for the Influenza A/B detection panel. Specimens from hospitalized patients that are positive for influenza A will be sent to UHL for subtyping as novel H1N1, seasonal H1, or seasonal H3.

Specimen Collection:

• Droplet Precautions (surgical mask) should be used by healthcare workers obtaining clinical specimens. If splashes are anticipated, eye protection should be worn.
• Nasopharyngeal swab: Collect specimen using the flexible minitip flocked swab (hospital stores #33595). Measure the distance from the patient's nostril to the nasopharynx (half the distance from nostril to base of the ear) and hold the swab at that location. Do not advance the swab beyond that point. Gently insert the swab along the base of one nostril (straight back, not upwards) and continue along the floor of the nasal passage until reaching the nasopharynx. Rotate swab 2-3 times and hold in place for 5 seconds. Place swab in tube containing viral transport medium. Break off the excess length of swab at the score mark to permit capping of the tube.
• Nasopharyngeal aspirate: A small catheter with a suction trap or bulb aspirator is inserted through the nostril into the nasopharynx (half the distance from nostril to base of the ear). Apply suction while slowly removing the catheter or aspirator tip. The catheter or aspirator tip should be flushed with viral transport medium (hospital stores #33595) or sterile saline. Transfer entire specimen into sterile, leak-proof container or viral transport medium tube.
• Nasopharyngeal wash: Instill several milliliters of sterile saline into nostrils while patient's head is tilted back. Bring patient's head forward and catch saline flowing from the nostrils in a sterile container. Transport specimen in sterile container or viral transport medium (hospital stores #33595).
• For patients who are intubated, an endotracheal aspirate should also be collected.
  
  

Transport specimens to the Microbiology laboratory (6004 BT) immediately on ice or refrigerate. From 2245 to 0700, deliver specimen to Specimen Control (6240 RCP) on ice. Questions regarding laboratory testing may be directed to Dr. Sandra Richter 6-2990 or Dr. Dan Diekema 4-5626.