Hand hygiene is one of the most important elements of infection control. The aim of hand washing is to remove transient micro-organisms, acquired through everyday tasks in the laboratory/ clinical setting, from the surface of the hands.
Good hand hygiene protects both patients and staff.
The World Health Organization (WHO) guidelines on “Hand Hygiene in Healthcare” describe five key situations where hand washing is required:
Infection prevention and control (IPC) practices are important in maintaining a safe environment for everyone by reducing the risk of the potential spread of disease.
IPC is a practical, evidence-based approach which prevents patients and health workers from being harmed by avoidable infection. It is relevant to health workers and patients at every single health-care encounter.
Random Blinded Rechecking (RBRC) is the process of re-reading a statistically valid sample of routine slides from a designated microscopy centre (DMC) based on lot quality assurance strategy (LQAS) in a blinded manner to assess the laboratory performance.
RBRC Process
Annual slide sample and the monthly sample for Random Blinded Rechecking (RBRC) is determined by the District TB Officer (DTO), assisted by the Intermediate Reference Laboratory (IRL), Statistical Assistant (SA) or Data Entry Operator (DEO) based on Lot Quality Assurance Sampling (LQAS) method.
Under the LQAS method, sample size depends on 3 components:
Process of RBRC (Figure 1)
Random Blinded Rechecking (RBRC) is an External Quality Assurance (EQA) method that provides reliable assurance that a district has an efficient Acid-fast Bacillus (AFB) microscopy laboratory network to support National TB Elimination Programme (NTEP) (Figure).
Blinded rechecking is a process of re-reading a statistically valid sample of slides from a laboratory to assess whether that laboratory has an acceptable level of performance.
Documentation of any significant problems (technical, operational, others) and feedback for corrective action during On-site Evaluation (OSE) is necessary to formulate plans with the District TB Officer (DTO), Senior TB Laboratory Supervisor (STLS), Medical Officer (MO), Intermediate Reference Laboratory (IRL), National Reference Laboratory (NRL) and Laboratory Technician (LT) to improve the quality of smear microscopy.
Checklists for OSE
A field visit is an ideal way to obtain a realistic assessment of the conditions and skills practiced in the laboratory. Under National TB Elimination Programme (NTEP), On-site Evaluation (OSE) of Intermediate Reference Laboratories (IRLs) and District TB Centres (DTCs)/ Designated Microscopy Centres (DMCs) is therefore an essential component of a meaningful Quality Assurance (QA) programme.
Panel testing is a method of External Quality Assurance (EQA) that is used to determine the adequacy of a laboratory technician to perform Acid-fast Bacillus (AFB) smear microscopy. This method evaluates individual performance in staining and reading and not the other laboratory activities.
Quality Assurance (QA) is a systematic process used to determine the quality standards of TB laboratories.
Poor quality diagnosis may results in failure to diagnose TB or unnecessary treatment of non-TB case. Thus an effective QA mechanism is important for reliability of laboratory diagnosis.
QA in National Tuberculosis Elimination Programme (NTEP) consists of: