To avoid compromising specimen integrity, please refrain from batching specimens before shipping to the state laboratory. Please submit isolates as soon as possible after collection and/or identification.

What are the criteria for duplicate Isolate Submissions?

AR isolates that are identical to recent submissions do not need to be submitted again to the state laboratory to save time and resources for both the laboratory and the submitter.

• If an AR isolate has already been submitted within the past 6 months from the same patient, same collection source, and same organism it does not need to be submitted again.
  4. If duplicate isolate(s) arrive with different specimen sources, the more invasive collection source is prioritized, ex: blood> sputum > wound.
  5. Isolates identified as duplicates will be canceled and the submitter will be notified.

• Exceptions: If there is a suspected change in AST profile, if there is suspicion of carbapenemase gene acquisition, or specific epidemiological request, we can test an isolate again. Please reach out to TexasARLN@dshs.texas.gov to request additional testing for duplicate isolates.

• Always include any previous laboratory reports such as antimicrobial susceptibility reports (AST) or identifications.
• Each specimen should have a corresponding specimen submission form.

Put the facility the specimen was collected at and the most relevant contact information for the facility. The AR Laboratory will reach out to this contact to confirm patient information and/or provide this information to other DSHS teams to notify local health departments and public health providers of results.

Sometimes, the location where the specimen was collected is different from the submitter detailed in Section 1. Section 7 allows this distinction to be made so that we can quickly contact the most relevant individual.

Here are a few examples of how Section 7 may be used for contact tracing and follow-up:

• Example 1: An AR swab was collected at a long-term acute care hospital (LTACH) and sent to a reference laboratory who regularly submits isolates to the state laboratory. The reference laboratory identified the specimen as a targeted organism and is submitting the isolate to the state laboratory.
  4. The reference laboratory’s submitter information will be pre-populated in Section 1.
• The LTACH’s information should be written in Section 7. The AR Laboratory can now reach out directly to the LTACH for follow-up.
• Example 2: An AR colonization screening was performed at a skilled nursing facility (SNF) that has never submitted specimens to the state laboratory before. A DSHS HAI Epidemiologist coordinated the screening with the local health department (LHD) who collected the specimens.
• The DSHS HAI Epidemiologist’s submitter information will be pre-populated in Section 1. The SNF’s Name and zip code should be written or printed in Section 7. Either the SNF or local health department who collected the specimen can provide their contact info in Section 7 for troubleshooting or follow-up from the laboratory.
• Example 3: A hospital who regularly submits specimens to the state laboratory is performing an AR colonization screening. This is coordinated between the hospital’s infection preventionist (IP) and DSHS HAI Epidemiologist.
• The hospital’s submitter info in Section 1 is accurate for general specimen submissions to the state laboratory. For these colonization screening specimens, the best point of contact for troubleshooting is the hospital’s IP. The IP’s info can be added in Section 7 for troubleshooting or follow-up from the lab.

For ARLN activities, such as GC AST and WGS of AR organisms, select box “Other” and write “CDC Special Project (14)” on the blank line.

Colonization screening supplies are provided after the colonization screening has been scheduled. A DSHS HAI Epidemiologist will coordinate distribution of supplies.

• Make sure your local health department (LHD) or another public health service provider is aware of and included in planning screening activities. Consult your LHD about the patients you want to screen, and coordinate with a DSHS HAI epidemiologist as needed. View a list of Local Health Departments, Public Health Districts, and Local Health Units in Texas.
• To proceed with requesting screening supplies, additional guidance, or support for more complex cases, contact DSHS HAI epidemiologists at HAIOutbreak@dshs.texas.gov.

Currently, we do not offer admission or discharge screenings for CRE, CRPA, CRAB, or Candida auris.

GC AST testing supplies are provided by the AR Laboratory as resources are available. Call (512) 776-7582 or email TexasARLN@dshs.texas.gov to request GC swab collection kits.