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UCLH NHS FOUNDATION TRUST
DEPARTMENT OF CLINICAL MICROBIOLOGY
USER MANUAL
January 2013
Version 4.5
UCL Hospitals is an NHS Foundation Trust incorporating the Eastman Dental
Hospital, Elizabeth Garrett Anderson & Obstetric Hospital, The Heart Hospital,
Hospital for Tropical Diseases, National Hospital for Neurology & Neurosurgery, The
Royal London Hospital for Integrated Medicine and University College Hospital
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TABLE OF CONTENTS
MISSION STATEMENT _______________________________________________________ 3 INTRODUCTION ____________________________________________________________ 3 LOCATION _________________________________________________________________ 4 POSTAL ADDRESS___________________________________________________________ 4 SERVICES AVAILABLE ______________________________________________________ 5 WORKING HOURS ___________________________________________________________ 7 CONTACTING US DURING WORKING HOURS __________________________________ 7 CONTACTING US OUT OF WORKING HOURS __________________________________ 7 KEY CONTACTS - LABORATORY ______________________________________________ 8 KEY CONTACTS – CONSULTANT MICROBIOLOGISTS___________________________ 8 COMPLAINTS _______________________________________________________________ 8 QUALITY ASSURANCE _______________________________________________________ 8 REQUEST FORMS AND SPECIMEN CONTAINERS ______________________________ 9 WHERE TO COLLECT SPECIMEN CONTAINERS _______________________________ 9 COLLECTION OF SPECIMENS_______________________________________________ 11 TRANSPORT OF SPECIMENS ________________________________________________ 11 COMMUNICATION OF RESULTS_____________________________________________ 11 OTHER SERVICES__________________________________________________________ 12 TURNAROUND TIMES, SPECIMEN TYPES, INVESTIGATIONS & CONTAINERS ___ 12 CONTAINER TYPES ________________________________________________________ 15 REFERENCE LABORATORIES _______________________________________________ 17 Microbiology User Manual version 4.5
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MISSION STATEMENT
We aim to provide our users with:
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
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A high quality, timely, clinical and diagnostic microbiology laboratory service
An expert clinical advisory service for the diagnosis, management and control of
infections
Assistance with the investigation of infectious disease outbreaks
Interesting and novel information relating to microbiology (e.g. antibiotic resistance
patterns)
A rapid response to comments, requests and complaints
INTRODUCTION
This guide describes the clinical and laboratory services available to users from the following
areas:





UCLH NHS Foundation Trust Hospitals:
o University College Hospital (UCH)
o Eastman Dental Hospital (EDH)
o The National Hospital for Neurology and Neurosurgery (NHNN)
o The Hospital for Tropical Diseases (HTD)
o University College Hospital Elizabeth Garrett Anderson Wing (EGA)
o The Heart Hospital (HH)
o The Royal London Hospital for Integrated Medicine (RLHIM)
o Macmillan Cancer Centre
Camden Primary Care Trust (PCT) (Mortimer Market and Archway Sexual Health Clinic)
Islington Primary Care Trust (PCT)
Camden & Islington Mental Health and Social Care Services Trust
Podiatry & Family Planning Services
This guide is intended to enable all users to make best use of the various services provided,
ensuring an accessible, equitable and efficient service.
Our workload
Our workload over recent years has continued to increase and alternative testing strategies
have been implemented in response to discussions with users and service needs.
During 2011, the laboratory processed 383,776 tests.
This comprised of:
 10.3% General Practice
 39.0% In-patient
 46.7% Out-patients
 4.0% Accident and Emergency
Accreditation
The Clinical Microbiology department holds full Clinical Pathology Accreditation (CPA Reference
number 0767).
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LOCATION
60 Whitfield Street
Nearest tube stations:


Warren Street Tube Station (Northern Line, Victoria Line)
Goodge Street Tube Station (Northern Line)
POSTAL ADDRESS
Department of Clinical Microbiology
University College Hospitals NHS Foundation Trust
60 Whitfield Street
London
W1T 4EU
www.uclh.nhs.uk
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SERVICES AVAILABLE
Routine microscopy, bacterial culture and sensitivity testing:
 All routine microbiological investigations including:
o Blood cultures
o CSF for microscopy and culture
o Bacteriology culture on swabs, fluids and tissues including:
 Brain material
 Wound swabs
 Respiratory samples including sputum and pleural fluids
 Genital cultures, including IUCDs
 Faecal cultures for enteric pathogens
o Fluids for Polarizing Microscopy
o Urine culture
Molecular MRSA detection:
 For routine screening using nose swabs, please refer to the Virology user manual
Routine mycology: Including Skin scrapings/Nail clippings
 Microscopy and culture for dermatophytes
 Extended culture for unusual exotic fungi
 Antibiotic and antifungal routine assay referral
Molecular Chlamydial and Gonococcal testing and other STI investigations:
 Please refer to the Virology user manual
Serological and rapid antibody/antigen detection:
 Serological investigations for Clinical Microbiology include:
o Clostridium difficile (Toxin and GDH) testing.
o Cryptococcal antigen (CRAG) test on serum and CSF
o Urine test for legionella and pneumococcal antigen
Antibiotic assays testing:
o Gentamicin
o Amikacin
o Vancomycin

Test performed in Biochemistry. For clinical advice please contact Clinical Microbiology
Department.
Mycobacterial investigations:
 Routine microscopy of all specimens for Mycobacterium species
 Rapid detection of Mycobacterium species using a liquid culture system
 Blood culture for all mycobacterial species
 All isolates are sent to the HPA Mycobacterium Reference Unit (MRU) for speciation and
antibiotic sensitivity testing
 Quantiferon testing is available upon request. Please consult with Microbiology clinical
team in advance.
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Environmental investigations
 Hydrotherapy pool water testing
Reference Laboratory Liaison
Many investigations including some molecular tests are available at various reference
facilities throughout the United Kingdom. If an investigation you require is not on this list,
please call the microbiology department for advice. We will receive the specimen in our
laboratory and refer it to the most appropriate reference facility.
Clinical Advice
Medical staff are available in the laboratory during working hours and on-call (out of hours)
to discuss cases and provide guidance on the diagnosis and management of infectious
diseases.
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WORKING HOURS
Regular working hours are Monday to Friday, 9 am to 5 pm, and Saturdays, 9 am to 4 pm.
If urgent investigations are required outside these times, there is an emergency on-call service
available 24 hours a day, 7 days a week.
During bank and public holidays, the department offers an emergency service only. However
some routine investigations may be processed during these periods.
CONTACTING US DURING WORKING HOURS
To contact us regarding laboratory enquiries - 020 3447 9913 or 020 3447 9651
To contact us for medical advice
Registrars office
Within UCLH
Fax:
020 344 79515 direct
ext 79515
020 344 79211
To contact us about general departmental enquiries
Admin office
Fax:
020 344 79912
020 344 79211
CONTACTING US OUT OF WORKING HOURS
On call Biomedical Scientist:
Air call bleep through switchboard: 0845 155 5000 /
020 3456 7890
On Call Specialist Registrar:
Contact through switchboard, see above numbers
On Call Microbiology Consultant:
Contact through switchboard, see above numbers
When using the out of hours service for requesting urgent laboratory investigations, please
make sure you contact the duty BMS in advance and inform them that a sample is on its way.
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KEY CONTACTS - LABORATORY
Microbiology Laboratory Service Manager
Mr. Massimo Bonaiti [email protected] 020 7307 7312
KEY CONTACTS – CONSULTANT MICROBIOLOGISTS
Clinical Lead
Dr. Bruce Macrae
[email protected] 020 344 79912
COMPLAINTS
If you wish to make a complaint, please contact the Laboratory Service Manager as detailed in the
earlier section and your complaint will be dealt with promptly.
QUALITY ASSURANCE
The laboratory is fully accredited by The Clinical Pathology Accreditation (CPA) (UK) Ltd. For
full details please refer to the CPA website www.cpa-uk.co.uk. This accreditation is an external
audit of our ability to provide a service of high quality in meeting all the necessary performance
standards.
The results sent out by this laboratory are of the highest possible quality. To this end we have a
Quality Management System (QMS) and participate in the UK National External Quality
Assurance Scheme (UKNEQAS) and Quality Control for Molecular Diagnostics (QCMD) for a
wide range of microbiological investigations. UKNEQAS/QCMD are central organisations that
operate on a country wide basis and monitors our performance regularly by sending simulated
samples for analysis. Our results and ongoing performance are available for inspection.
The Department holds a monthly Quality Committee meeting where internal and external quality
is monitored. The meeting receives reports on audits of the quality system and looks at
turnaround times and error reports. A full time dedicated Specialty Quality Manager is
responsible for ensuring that high standards are maintained throughout our services.
All testing procedures and results are subject to strict internal quality control and regular audits.
User Surveys are undertaken to receive feedback on the service and to review testing profiles
and indicate where improvements to the overall service may be made.
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REQUEST FORMS AND SPECIMEN CONTAINERS
To enable us to provide a high quality result, it is essential that a correctly labelled form and
specimen are received in the laboratory. If specimens are accompanied by the wrong request
form, this will result in unnecessary delays or loss of specimen.
Request forms are clearly labelled as “Microbiology” request forms and have a bag attached for
the specimen.
If more than one examination is required, please send separate request forms and specimens
for each investigation to prevent delays in testing.
Do not use pins or staples as this is hazardous.
Please ensure that the correct sample container is used. A full pictorial guide to sample containers
can be found at the end of this user guide.
Complete patient details must be clearly marked on BOTH the request form AND the specimen
container before insertion into the plastic bag and sealed ready for transportation.
The minimum data we require for patient details are:
 Hospital Number (for GP’s – NHS number is required)
 Patient surname AND first name (please use ONLY capital letters)
 Date of Birth
 Sex
You must provide contact details of the person requesting an investigation. If there is no ward
details or appropriate contact number on a request form the Clinical Microbiology cannot
guarantee contacting the requestor.
It is essential that the proper clinical samples are collected at the appropriate time. This
enables as accurate a diagnosis as possible to be made. It will also guide the laboratory with
regard to what tests should be performed.
The importance of accuracy when completing the form, labelling the specimen, and the
provision of relevant clinical details including antibiotic chemotherapy cannot be overemphasised. For patient safety reasons, mislabelled specimens will not be processed.
WHERE TO COLLECT SPECIMEN CONTAINERS
a) FOR GP BASED REQUESTS
Dermapak
A DERMAPAK fungal specimen collection pack will be sent via the post upon submission of
a written or telephoned request to Clinical Microbiology.
Request for other laboratory consumables
For routine GP requests for all laboratory consumables (urine pots, swabs, request forms
etc), please complete proforma list (A) and fax to Interserve (020 3447 7793) who will
arrange for items to be supplied. Any queries telephone Interserve on Hospital extension
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77791. There are no facilities within the Clinical Microbiology Department to supply
collection kits for all other specimen types.
b) FOR UCLH BASED REQUESTS
Blood cultures
Clinical Microbiology supply blood cultures to the following wards, T01, T03, T08, T13N and
T16S. These wards hold the stock for the Hospital.
Paediatric blood cultures are stocked by NNU (ITU)
Stocks on these wards are supplied from Microbiology and are restocked each Thursday.
Bottles are available for all wards and departments who wish to use them. Please avoid
“stocking up” in a particular location as the bottles do have an expiry date and out of date
bottles will not be tested if received.
Blood culture bottles may be requested for use from the Heart Hospital and St Pancras. One
box of aerobic and anaerobic culture bottles is sent to the Heart Hospital ITU via the usual
courier services when a request is received. St Pancras will phone up in advance and send
across a courier to pick up 6 sets of culture bottles for use.
Blood culture bottles for NHNN wards are stored in the NHNN phlebotomy department. Any
queries should be directed to Stephanie O’Donnell on x83398.
HTD OPD can contact the department to arrange stock
Mortimer Market blood cultures bottles and mycobacteria bottles are stored in the ‘hotlab’ for
use in Mortimer Market and Bloomsbury clinics
TB Blood cultures/TB EMU bottles
Stocks are no longer kept in Microbiology and all requests for supplies should be referred to
T8 (x70800) where small numbers of bottles are kept for use.
Request for laboratory consumables
For the main UCH site, all stock laboratory specimen containers for ward use may be
obtained via NHS Logistics.
Please note: The laboratory does not keep supplies of consumables for ward use.
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COLLECTION OF SPECIMENS
To enable us to provide you with the best quality results, it is essential that good specimens are
collected properly, at the appropriate time and before the administration of antibiotics. It is also
important that they are transported to the laboratory without undue delay. This enables the
laboratory and the medical staff to provide a meaningful report and an interpretation relevant to
the patient's illness.
Inappropriate specimens (i.e. vomit, nasal discharge, Foley’s catheter tip) or those that are
damaged or leaking are liable to be discarded. Should this occur, every attempt will be made to
inform the user that, if appropriate, a second specimen may be required?
If unsure which specimen type to examine or how to collect a particular specimen type, please
contact the laboratory (020 344 79651) for advice.
High Risk Specimens
High risk specimens should be sent to the laboratory using appropriate packaging. Please
discuss with the Clinical Microbiologists if there is significant risk for example Viral
Heamorrhagic Fever (VHF) or Creutzfeldt–Jakob disease (CJD).
TRANSPORT OF SPECIMENS
Please refer to your local transport policy and arrangements. This is available on the UCLH
Foundation Trusts Intranet site.
Specimens should be sent direct to the Clinical Microbiology Reception at 60 Whitfield Street.
Generally, specimens that are not sent within two hours of taking (excluding blood cultures)
must be stored in a fridge at +4oC until transported to the laboratory. Please contact the
laboratory if there are specific questions regarding transportation of specimens.
Routine specimens from UCLH should be sent via the pneumatic tube system.
Samples from other sites, including GPs, should be sent using the regular courier service to the
60 Whitfield Street reception.
Urgent out of hour’s samples MUST be sent to the Clinical Microbiology Laboratory by
courier. Failure to do so may mean that samples may be delayed in processing.
The sender is responsible for ensuring the health and safety of any courier or taxi
service that is used to transport samples to the Clinical Microbiology laboratory.
If specimens are to be brought to specimen reception personally by medical or nursing staff they
must be carried in an approved container for transport.
COMMUNICATION OF RESULTS
All clinically relevant and urgent positive results are telephoned out to our users by one of the
medical staff. For reasons of confidentiality, results are only faxed to “safe-haven fax numbers”.
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OTHER SERVICES
Advice concerning disinfection, sterilisation, infection and environmental control are also
available at any time from the Medical Microbiologists.
Samples may be referred to HPA Reference laboratories for more specific tests where routine
testing at UCLH is not provided.
TURNAROUND TIMES, SPECIMEN TYPES, INVESTIGATIONS &
CONTAINERS
Expected turnaround times are given as working days and are based on the time of arrival in the
Clinical Microbiology Laboratory, 60 Whitfield Street. Exceptions are specimens for TB and
Serology, which are processed on weekdays only.
Where appropriate, turnaround times are given for microscopy. Turnaround times for culture are
given with a range of times. The lower figure is for a “negative” result (where there has been no
follow up of an isolate) and the higher for a “positive” result (where an isolate has been followed
up, identified and antibiotic sensitivities determined). Exceptions are mycobacterial culture and
blood culture where a negative result is only issued at the end of the full incubation period.
Fungal culture results are automatically issued (negative) at 14 days but some may be kept for
4-6 weeks.
The following table indicates expected turnaround times and the types of specimen containers
that should be used for diagnostic testing. The container types are illustrated in the pictures that
follow. Any special handling requirements prior to receipt in microbiology and key factors known
to affect the performance of tests are listed in the table below.
Please note that we do not keep all samples once tested so if extra tests are required please
phone the laboratory (020 3447 9913) at the earliest opportunity to request the additions, please
see table below for approximate sample retention times
Sample type
Container
Anaerobe investigations
Swab B,
Pus C & D
Blood for culture
F, G
Blood for serology
E
Blood: antibiotic
levels
(Gent / Vanc / Amik)
E
Microbiology User Manual version 4.5
Specimen
Retention
time
Expected Turnaround time/Notes
Preliminary isolation: 2-4 days
Full identification and susceptibility: 2-4 additional
days
Cultures: kept up for a total of 5 days
Identification and susceptibility within 2 days of
growth.
Ensure Blood cultures are collected using aseptic
technique.
Never place blood cultures in the refrigerator.
In-house: varies according to test
Reference Laboratory: may take up to 14 days
Please consult laboratory for individual turnaround
time
Same day testing >95% of samples.
(tested in Biochemistry)
Please contact the Microbiology doctors for
interpretation of antibiotic levels. It is important to
state time and dose regime to aid in interpretation.
Other antibiotic assays are sent away for testing, may
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7 days
Minimum
2 days
7 days
7 days
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Catheter tips / lines
C, D
Cerebrospinal fluid
C
Eye / Ear swabs
Faeces
A
C and D
Faeces for C.difficile
(Toxin and GDH).
C and D
Fluid / Aspirates / Pus
(synovial, pleural, bile,
etc.)
Genital swabs (HVS)
Genital swabs (Cervical)
Genital swabs (male
urethral)
Hydrotherapy Pool
Water
IUCD
Leprosy – slit skin
smear
MRSA screen: agar
Tissue, bone, biopsies
etc.
Tissue etc. for mycology
7 days
7 days
M
2-4 days
7 days
J
2-4days
1 day
2-4 days. Extended cultures for Actinomyces spp.
7 days
5 days from receipt in lab
2 years
2-4 days.
7 days
2-4 days
Cultures: kept up for a total of 7 days.
2–3 days to identify following initial isolation.
Specialist culture media required eg B. pertussis.
Please contact the Microbiology Department before
sending.
Full identification within 3 days of culture
Microscopy: 1 working day
Culture: within 28 days
Identification within 2 weeks of culture
2-4 days
2-4 days. Cultures extended for F. necrophorum
investigation.
Microscopy: 1 working day
2-4 days
Cultures: kept up for 4 weeks
Cultures: kept up for 6 weeks
Identification within 1 week and susceptibilities within
3 weeks of growth
Auramine: 1 working day
Liquid Cultures: kept up for 6 weeks
Identification within 1 week and susceptibilities within
3 weeks of growth
2 days
Microscopy is not performed
Liquid Cultures: kept up for 6 weeks
Identification within 1 week and susceptibilities within
7 days
D
Inoculated
smears
A
C and D
K
C and D
A
C and D
C and D
TB: Blood and bone
marrow
H
TB: Cerebrospinal fluid
C
TB: Drug compliance
TB: Early morning Urine
(EMU)
7 days
2-4 days
2-4 days
L
Throat swab
7 days
7 days
A
B
Pernasal swab
Sputum or BAL
3 months
7 days
A
Skin, nails, hair for
fungi
7 days
Microscopy: 1 working day
2–4 days
C and D
Neonatal swabs
Prosthetic heart valve
take up to 14 days.
2-4 days
Microscopy: same day
Cultures: kept up for a total of 5 days
Identification and susceptibilities within 2 days of
growth.
At least 0.5ml of CSF is required for optimal testing.
CSFs received >24 hours after collection are
unsuitable for cell count.
2-4 days
2-4 days
Same day testing >95% of samples
Batched and tested daily Mon – Sun with a same day
result
C and D
I
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7 days
1 month
7 days
7 days
7 days
1 month
1 month
6 weeks
6 weeks
7 days
7 days
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3 weeks of growth
TB: Fluid / Aspirates /
Pus
TB: Sputum or BAL
TB: Tissues
Urine: MSU or CSU
Urine antigen testing
(Legionella or
pneumococal)
Wound swab
C
C and D
C and D
D
C and D
A
Microbiology User Manual version 4.5
Auramine: 1 working day
Liquid Cultures: kept up for 6 weeks
Identification within 1 week and susceptibilities within
3 weeks of growth
1-2 days
1-2 days
ONLY by prior agreement with the Microbiology
doctor.
2-4 days
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6 weeks
1 month
6 weeks
2 days
7 days
7 days
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CONTAINER TYPES
For key to container types, please refer to table above.
B
A
Transwab (clear jelly)
Charcoal Transwab (black jelly)
C
D
Sterile universal container (60ml)
Sterile universal container (30ml)
E
F
7 ml clotted blood containers
Adult bottle set
(blue and purple tabs)
G
Paediatric bottle (pink tab)
Microbiology User Manual version 4.5
H
Mycobacteria blood culture bottle
(Bactec Myco/F – lytic) with Red tab
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I
J
Hydrotherapy pool water container
EMU container
(contains Tannic acid)
K
L
Pernasal swab
for pertussis culture only
Dermapak
M
Male Genital (orange) swab pack
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REFERENCE LABORATORIES
The following Reference Laboratories are used for confirmation and specialist testing services.
Addresses of the laboratories that we refer samples to are available on request.
For any test not listed in the sections below refer to the HPA website which has a reference of
Specialist Reference Microbiology Tests and Services:
http://www.hpa.org.uk/ProductsServices/InfectiousDiseases/MicrobiologicalTestsAndServices/c
fiIndexTestsServicesMicrobio/
SEROLOGY (based on name of organism)
Anaplasma
Lyme reference Laboratory, Southampton General Hospital
Aspergillus
Mycology Reference Centre, Leeds
Avian
Mycology Reference Centre, Leeds
Bartonella
Respiratory and Systemic Infection Laboratory, Colindale
Blastomyces
Mycology Reference Laboratory, Bristol
Bordetella
Respiratory and Systemic Infection Laboratory, Colindale
Brucella
Brucella Reference Unit (BRU), Liverpool
Campylobacter
Microbiology Laboratory, Royal Preston Hospital, Preston
Candida
Mycology Reference Centre, Leeds
Corynebacterium diphtheriae
Streptococcus & Diphtheria Reference Unit, Colindale
Clostridium tetani (tetanus)
Respiratory and Systemic Infection Laboratory, Colindale
Coccidioides
Mycology Reference Laboratory, Bristol
Coxiella
Special Pathogens Reference Unit, Porton Down
E coli O157
Laboratory for Enteric Pathogens, Colindale
Francisella
Special Pathogens Reference Unit, Porton Down
Histoplasma
Mycology Reference Laboratory, Bristol
Legionella
Atypical Pneumonia Unit, HPA, Colindale
Leptospira
Leptospirosis Reference Laboratory, Hereford
Neisseria meningitidis
Meningococcal Reference Unit, Manchester
Paracoccidioides
Mycology Reference Laboratory, Bristol
Rickettsia
Special Pathogens Reference Unit, Porton Down
Staphylococcus aureus
Laboratory of HealthCare Associated Infection, Colindale
Streptococcus pneumoniae
City Hospital, Dudley Road, Birmingham
Treponema (syphilis)
Sexually Transmitted Bacteria Reference Laboratory, Colindale
Toxoplasma
Toxoplasma Reference Laboratory (TRL), Swansea
Yersinia
Laboratory for Enteric Pathogens, Colindale
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ANTIBIOTIC AND ANTIFUNGAL LEVELS
Streptomycin
Other antibiotic levels
Antimicrobial Reference Laboratory, Bristol
Tobramycin
Royal London Hospital, London
Itraconazole, Amikacin,
Gentamicin, Teicoplanin
Royal Free Hospital, London
5 Flucytosine, Itraconazole,
Voriconazole
Mycology Reference Laboratory, Bristol
CULTURE OR SPECIMENS
Anaerobes / Actinomyces
Anaerobe Reference Laboratory, Cardiff
Bacillus anthracis
Special Pathogens Reference Unit, Porton Down
Bartonella
Atypical Pneumonia Unit, RSIL, Colindale
Bordetella
Atypical Pneumonia Unit, RSIL, Colindale
Campylobacter
Laboratory for Enteric Pathogens, Colindale
Chlamydia (respiratory)
Atypical Pneumonia Unit, RSIL, Colindale
Corynebacterium diphtheriae
Respiratory and Systemic Infection Laboratory, Colindale
E coli O157
Laboratory for Enteric Pathogens, Colindale
Haemophilus
Haemophilus Reference Unit, Colindale
Helicobacter spp.
Laboratory for Enteric Pathogens, Colindale
Legionella
Atypical Pneumonia Unit, RSIL, Colindale
Mycology
Mycology Reference Laboratory, Bristol
Mycoplasma
Atypical Pneumonia Unit, RSIL, Colindale
Neisseria gonorrhoeae
Sexually Transmitted Bacteria Reference Laboratory, Colindale
Neisseria meningitidis
Meningococcal Reference Unit, Manchester
Salmonella species
Laboratory for Enteric Pathogens, Colindale
Shigella species
Laboratory for Enteric Pathogens, Colindale
Streptococcus pneumoniae
Streptococcus & Diphtheria Reference Unit, Colindale
Yersinia
Laboratory for Enteric Pathogens, Colindale
For antibiotic resistance testing
Antibiotic Resistance Monitoring and Reference Laboratory,
Colindale
For typing
Laboratory of HealthCare Associated Infection
Epidemiological Typing Unit, Colindale
16S rDNA PCR
Microbiology Laboratory, Great Ormond Street Hospital
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