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    To ensure that specimens meet laboratory acceptance criteria, please review all appropriate content prior to specimen submission.

    Name Sort descending Updated Required form Specimen Collection and Submission Instructions Pre-approval Requirement Procedure, if applicable Methodology Testing Frequency Turnaround Time (business days) Comments Footnotes Contact Notifiable Conditions Info
    Candida auris screening
    Candida, Fungal, AFST
    12/13/2023

    Collect isolates by swabbing the patient's axilla and groin. Transport in a BD Eswab with 1.0mL Amies Buffer. Submit Eswab isolates immediately on ice to be tested within 9 days of collection.

    Pre-approval required.

    Must be approved by submitter jurisdiction's Healthcare-Associated Infections (HAI) coordinatior prior to submitting to ARLN.

    Real-Time PCR performed to confirm C. auris

    Culture based testing will be performed on positives and discordant results, this will affect turnaround time.

    Daily, on regular business days

    2-3 business days (PCR)

    7-14 business days (culture-based screening)

    *This screening method was developed by the Centers for Disease Control and Prevention (CDC). Its performance characteristics have been validated by the WA State PHL. An inability to recover or isolate C. auris does not exclude the possibility of patient colonization. Results are not approved by the FDA and are for infection control and epidemiological purposes, and should not be used for the sole basis of diagnosis or patient treatment.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Candida species Identification and Fungal Susceptibility Testing
    Candida, Fungal, AFST
    12/13/2023

    Submit clonal Isolates (selected from a single colony) on a Sabouraud's Dextrose agar slant or other appropriate media at room temperature.

    Isolates are stable for 2-3 weeks and may be stored for batch submission.

    Please refer to additional collection and submission instructions: SCSI-ARLN-Candida-AFST.

    Pre-approval not required.

    Testing limited to Candida spp. excluding C. albicans.

    Confirmatory identification performed using MALDI-TOF mass spectrometry.*

    Antifungal susceptibility tested by broth microdilution following the most current CLSI interpretations.

    Amphotericin B will be tested using Etest strips.

    Daily, on regular business days.

    7 business days

    For Washington State only: As of January 1, 2023, Candida auris is a notifiable condition in Washington State. Washington State health care providers and facilities must notify their local health jurisdiction within 24 hours of C.auris identification. Laboratories must notify the local health jurisdiction within 24 hours and submission to WA PHL is required. Please reference here for additional information

    *This test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL, it has not been approved by the FDA and is not intended for clinical patient management.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Neisseria gonorrhoeae Antimicrobial Susceptibility Testing
    N. gonorrhoeae, GC
    09/17/2019

    Submit isolates derived from urethral discharge specimens and other anatomic sites (e.g., vaginal, endocervical, pharyngeal, and/or rectal specimen-derived isolates), and collected from patients presenting at CDC-selected sexually transmitted disease clinics (sentinel sites).

    N. gonorrhoeae isolates will be initially processed at CDC-selected sentinel site laboratories. Those presumptively identified as N. gonorrhoeae by Gram stain and oxidase reaction will be shipped for bacterial identification and antimicrobial susceptibility testing.

    Please refer to additional collection and submission instructions: SCSI-ARLN-GC

    Identification of all isolates presumed to be N. gonorrhoeae confirmed by carbohydrate utilization and DNA hybridization. Antimicrobial susceptibility performed by agar dilution.

    Twice monthly, or as needed.

    1-2 weeks

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Carbapenem-resistant Acinetobacter
    CR-Acinetobacter, CRAB, CR-AB
    12/13/2023

    Submit Acinetobacter resistant to imipenem, meropenem, or doripenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 μg/mL).

    Transport on Tryptic Soy Agar Slant or equivalent at room temperature.

    Please refer to additional collection and submission instructions: SCSI-ARLN-CRAB

    Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry.

    Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest.

    Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*

    Daily, on regular business days.

    2-3 business days

    Interested clinical labs may enroll as sentinel labs. Sentinel labs will receive benefits such as free materials for isolate submission. Please contact the AR Lab Network if interested.

    *Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing.

    Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL, it has not been approved by the FDA and is not intended for clinical patient management.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Carbapenem-resistant Pseudomonas
    CR-Pseudomonas, CRPA, CR-PA, Pseudomonas aeruginosa
    01/30/2020

    Submit P. aeruginosa isolates that are resistant to imipenem, meropenem, or doripenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 μg/mL) AND non-susceptible or resistant to ceftazidime or cefepime (i.e. minimum inhibitory concentrations of >16 ug/mL.

    Transport on a Tryptic Soy Agar Slant or equivalent at room temperature.

    Please refer to additional collection and submission instructions: SCSI-ARLN-CRPA

    Pre-approval not required.

    Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry.

    Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest.

    Phenotypic detection of carbapenemase production by CLSI Modified Carbapenem Inactivation Method (mCIM).

    Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*

    Daily, on regular business days

    2-3 business days

    Only pure isolates will be tested; Mucoid isolates should be excluded.
    Washington State DOH requests voluntary submission of carbapenem-resistant Pseudomonas from Washington sentinal labs.

    *Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing.

    Modified Carbapenem Inactivation Method is a CLSI standard and is not approved by the FDA. Performance characteristics have been verified by the WA State PHL.

    Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL.It has not been approved by the FDA, and is not intended for clinical patient management.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Carbapenem-resistant Enterobacterales (CRE)
    E.coli, Klebsiella, Enterobacter, CRE, Multi-drug resistant organism, MDRO
    12/13/2023

    Submit Escherichia coli, Klebsiella spp, and Enterobacter spp that are resistant to imipenem, meropenem, doripenem, or ertapenem by standard susceptibility testing methods (i.e. minimum inhibitory concentrations of >=4 μg/mL for doripenem, imipenem or meropenem or >=2 μg/mL for ertapenem).

    Transport on a Tryptic Soy Agar Slant or equivalent at room temperature.

    Please refer to additional collection and submission instructions: SCSI-CRE-Testing

    Pre-approval not required.

    Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry.

    Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest.

    Phenotypic detection of carbapenemase production by CLSI Modified Carbapenem Inactivation Method (mCIM).

    Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*

    Daily, on regular business days.

    2-3 business days

    For Washington State only: As of January 1, 2023, Carbapenem-resistant and carbapenemase-producing Enterobacterales must be sent to WA PHL within 2 business days of detection.

    *Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing.

    Modified Carbapenem Inactivation Method is a CLSI standard and is not approved by the FDA. Performance characteristics have been verified by the WA State PHL.

    Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL.It has not been approved by the FDA, and is not intended for clinical patient management.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Carbapenemase-producing Organism (CPO) Colonization Surveillance Screening 04/24/2023

    Collect rectal swabs using the Copan dual-swab for testing using the Cepheid GeneXpert assay.

    Insert swab in the tube’s universal transport media. Ship at room temperature (15- 28C) to the Regional Laboratory within 1 day of collection.

    Pre-approval required.

    Must be approved by submitter jurisdictions's Healthcare-associated Infections (HAI) coordinatior prior to submitting to ARLN.

    FDA approved Cepheid GeneXpert Carba-R assay for the detection of Carbapenemase genes KPC, NDM, VIM, IMP-1 group and OXA-48 (also covering OXA-181 and OXA-232).*

    As needed (available on regular business days).

    24-48 hours

    Patient swabs should be mailed immediately following collection. Avoid shipping on Fridays.

    Copan dual swabs are viable for testing <5 days after patient collection.

    Stool specimens may be considered on a case by case basis; Contact HAI coordinator for additional information.

    *Detection of resistance mechanisms is restricted to the target capacity of the assay’s primers and probes. Non-detected targets does not exclude the presence of variants, or other rare carbapenemase genes or resistance mechanisms.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Detection of IMP-variants 12/13/2023

    Submit isolates that are mCIM positive, but negative for KPC, NDM, VIM, OXA-48, and IMP with molecular testing.

    Transport on a Tryptic Soy Agar slant or equivalent at room temperature

    Please refer to additional collection and submission instructions: SCSI-ARLN-IMP

    Real-Time PCR to detect IMP-1, IMP-4, IMP-13, IMP-14, IMP-18, IMP-26, and IMP-27 in a single reaction with lysates prepared from gram negative bacteria.

    Every other week based on testing volume

    7-10 business days

    This test is performed when phenotypic results are discordant with standard molecular methods for detection of common carbapenemase producing genes.

    ARLN Laboratory (206) 418-5478

    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Detection of OXA-variants 12/13/2023

    Submit Acinetobacter resistant to imipenem, meropenem, or doripenem by stadard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 ug/mL).

    Transport on a Tryptic Soy Agar slant or equivalent at room temperature

    Please refer to additional collection and submision instructions: SCSI-ARLN-OXA

    Real-Time PCR to detect OXA-23-like, OXA-24/40-like, OXA-58-like, and OXA-235-like in a single reaction with lysates prepared from gram negative bacteria.

    Every other week based on testing volume

    7-10 business days

    This test is performed when antibiotic susceptibility testing results are discordant with standard molecular methods for detection of common carbapenemase producing genes.

    ARLN Laboratory (206) 418-5478

    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Expanded Antimicrobial Susceptibility Testing for Hard to Treat Infections (ExAST) 12/13/2023

    This project is intended to inform clinical decisions for highly resistant infections.

    Submit Enterobacterales isolates that:

    • test non-susceptible to all beta-lactams, including either ceftazidime-avibactam or meropenem-vaborbactam
    • have NDM, VIM, or IMP genes confirmed by molecular testing

    Transport on a Tryptic Soy Agar slant or equivalent at room temperature

    Please refer to additional collection and submission instructions: SCSI-ARLN-ExAST

    Pre-authorization is required. Please contact ARLN@doh.wa.gov

    Isolates will be tested to confirm carbapenem resistance, carbapenemase production, and to identify carbapenemase gene-coded resistance.

    Isolates that meet inclusion criteria will be tested for susceptibility to ceftazidime+avibactam, aztreonam and avibactam+aztreonam

    as needed

    3 business days

    ARLN laboratory (206) 418-5478

    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Gradient Strip Neisseria gonorrhoeae Antimicrobial Susceptibility Testing (pre-approval required) 11/16/2021

    Submit N. gonorrhoeae isolates or clinical samples associated with suspected treatment failures.

    Isolates of either confirmed or suspected N. gonorrhoeae grown in pure culture on media slants OR clinical samples collected from patients and inoculated onto an InTray are accepted.

    Pre-approval is required, specimens sent without approval will not be tested. Please email ARLN@doh.wa.gov

    Testing is conducted at the AR Lab Network Partner Laboratory (University of Washington Neisseria Reference Laboratory), do not send specimens to WA PHL

    Please refer to additional collection and submission instructions:
    SCSI-ARLN-GC-E-TEST

    Required Form: ARLN-GC E-test Requisition Form

    Antimicrobial susceptibility testing (AST) by gradient strip (Biomerieux E-test strips).

    As needed

    10 business days

    This test is performed when treatment failure is suspected

    ARLN Laboratory (206) 418-5478
    ARLN@doh.wa.gov
    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
    Targeted surveillance screening 01/24/2020

    Collect rectal swabs Copan dual-swab for testing using culture-based screening. Please note that other anatomical sites will be considered upon request and approval by the AR Lab network.

    Insert swab into the tube's universal transport media. Ship at room temperature (15-18C) to the regional laboratory within 5 days of collection.

    Please refer to additional collection and submission instructions: SCSI-ARLN-Targeted Surveillance Screening

    Pre-approval required.

    Must be approved by submitter jurisdiction's healthcare-associated infections (HAI) coordinator prior to submitting to the AR Lab Network.

    Isolates extracted from culture-based screening will be tested for targets of interest.

    As needed (available on regular business days)

    7-10 business days

    Patient swabs should be mailed immediately following collection. Avoid shipping on Fridays.

    Copan dual swabs are viable for testing <5 days after patient collection.

    *Detection of resistance mechanisms is restricted to the target capacity of fthe assay's primers and probes. Non-detected targets does not exclude the presence of variants, or other rare carbapenemase genes or resistance mechanisms.

    Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.

    ARLN Laboratory (206) 418-5478

    Mike Tran (206) 418-5459

    Notifiable Conditions Overview
    List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)