STLS

The following work practices are recommended to ensure that microscopy laboratory technicians are not exposed to aerosols from sputum specimens.

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:

• Standard precautions are a group of infection control practices to reduce the risk of transmission of pathogens.
• These are based on the principle that all blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may contain
  transmissible infectious agents.
• Standard precautions are applicable to all patients in all healthcare settings and combine the major features of universal precautions, body substance isolation, and airborne precautions.

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

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: