# Presentation: 528814

## TB Bacteriology Workshop

- “ The Way Forward”
- Quality Assurance Plans

## Role in HIV Care and Treatment 

- Role for quality control of microbiology and susceptibility test procedures
- Use of gram stain on proper specimens for rapid diagnosis in case of meningitis, septicemia
-  Quality control of culture techniques.
-  Documentation of QC media prepared within each lab where cultures are performed.

## Specimen Transport

- Use of CPC for specimens from long distances
- Transport from HC to District and Province
- From Province to CDL for culture

## Decontamination of Specimens 

- Monitor the number of isolates which grow compared to the number of smear positive and smear negative specimens
- Smear positive specimens- highly smear positive should expect growth
- Smear negative specimens- even some smear negative should grow in culture

##  Zeihl Neelsen Stain

- Perform positive and negative quality control strains- when stain reagents are prepared.
- Record results of control slides include date of preparation of each reagent.
-  How often are QC srains performed after initial stain has been made?  Performed daily or weekly?

## Zeihl Neelsen Cont’d

- When experienced staff are performing ZN, QC slides should be performed with each stain.
- What are the benefits for this?
- Results of quality control should be recorded on a separate QC log.

## Auramine-O Stain

- Perform QC slides each time smears are stained
- Record results on a separate log for A-O stain
- Log the time when the FA scope is turned on and turned off even though there is a monitor on the scope
- Monitor the quality of reading of AFB smears by AO with ZN or either by having a sample screened by re-staining with A-O stain.
- Closely monitor results of A-O staining to confirm the accuracy of results with data for publication to IUATLD/WHO

## QC Smear Results

- Perform QC using a smear positive patient sputum to confirm that decontamination procedure is working ie that AFB are not being killed – should grow on L-J or MGIT

## Bacteriology QC Sensitivity

- Use standard quality control strains for each type of antibiotics, GN and GP
- Use of antibiotics in hospital formularly
- Meet with Pharmacy, Infection Control and Physicians on interpretation of antibiotic results provided in the laboratory
- Test proper antibiotic for the type of organism and specimen from which the isolate was taken.

## Culture and Identification Media 

- Confirm sterility before media is placed into use
- Confirm  media is working properly with positive and negative control organisms
- Record date, lot number of medium or ingredient used as well as results for each batch of media prepared.
- Compare growth on culture media to what was observed on the direct gram stain of the clinical specimen
- Confirm the gram stain of isolate prior to antibiotic susceptibility testing and performing biochemical reactions

## Quality Assurance

- Intra-laboratory reproducibility
- How well results agreement among technicians within the same laboratory
- Inter-laboratory reproducibility
- How well results agree among different labs within the country
- Correlation of laboratory results- smear vs culture

## How Do We Measure Progress

- What shall we report to the National Level?
- What should the National Level report to the Provinces, Districts?
- How often shall we report
- Why should we report?
- Advantages and disadvantages of reporting

## Should We Fly With Eagles?

- Or stay on the roost???