External Quality Assessment of Tuberculosis Laboratories
Started by Gabriela Torrea on 18 Feb 2009
Has anybody experience and/or knowledge about External Quality Control system implemented in TB laboratories, particularly for egg-based solid media culture (SMC) and broth-based culture(BBC)?
Keywords: Clinical Guidelines, General Resources, broth-based culture BBC, solid media culture SMC
Tom Nicholson
Hello Ms. Torrea,
I have forwarded your question on to some experts Parterns In Health collaborates with in Tomsk, Russia and here in the US.
Hopefully I will be able to provide you with some resources on this topic very soon.
Best,
Tom Nicholson
1:01 PM, 23 Feb 2009 | Permalink
Gabriela Torrea
Dear Tom Nicholson,
Thank you very much for your response, I greatly appreciate your kindness as I am keen on developing this topic as soon as possible.
4:27 AM, 24 Feb 2009 | Permalink
Rebecca Weintraub, MD
Quality Assurance, particularly for cultures, remains a critical challenge for TB laboratories in resource limited settings. I do not have on-the-ground experience in this arena but several colleagues suggested a few reference documents, links, and articles – see list below. Our team has also invited members of the Supra-National Reference Laboratories to join the discussion, and I hope that members of the community will share their implementation guidelines and experience. I would guess that answers will vary greatly depending on the settings and NTPs.
* Guidelines for Surveillance of Drug Resistance in Tuberculosis put together by the WHO and the International Union Against Tuberculosis and Lung Disease (The Union) published in 2003: http://whqlibdoc.who.int/publications/2003/9241546336.pdf
Particularly Chapter 29: National Reference Laboratory and Supra-National Reference Laboratories information, also the forms and check lists in Annexes
* The Interim recommendations for the surveillance of drug resistance in tuberculosis, WHO, May 2007: http://whqlibdoc.who.int/hq/2007/WHO_HTM_TB_2007.385_eng.pdf
Chapter 3: Laboratory
* In 2005, the Union also published a handbook with the Institute of Medical and Veterinary Science in Australia for the Pacific Island Countries: Laboratory Diagnosis of Tuberculosis by Sputum Microscopy: http://www.theunion.org/download/labcontrol/Adelaide_document.pdf which gives pointers for QC in the appendices (page 37).
* This short communication published in February 2008, is also a valuable resource: External quality control of Mycobacterium tuberculosis drug susceptibility testing: results of two rounds in endemic countries: http://www.ingentaconnect.com/content/iuatld/ijtld/2008/00000012/00000002/art00016?crawler=true
Hope this helps.
12:27 PM, 2 Mar 2009 | Permalink
Marina Shulgina
Dear colleagues,
The Russian National Centre for EQA in laboratory medicine is conducting proficiency testing in culturing and DST since 2001-2002. As DST PTs' methodology is well known and is already described in previous replies, I will briefly describe the culture PT module. We use a panel of 10 control samples, which includes lyophilized cultures of M. tuberculosis in two CFU concentrations (103 and 104 f.e), fast growing NTBM and E.coli. PTs are performed once a year. It can be used for egg media and for liquid media as well. Absolute majority of participants are using egg media. Low concentrations of M. tuberculosis can be probably used for liquid media culturing. Decontamination is not included into the samples’ processing so we are actually assessing the media, cultivation process and performance 0f identification procedure by time of growth, AFB staining and type of colonies. We are planning to use liquid suspension of bacteria as control samples for limited number of laboratories this year. In this case we will include decontamination procedure into the samples processing.
1:47 PM, 11 Mar 2009 | Permalink
Gabriela Torrea
Dear Rebecca Weintraub,
Thank you for your valuable reply. I know very well these documents that are relevant for this topic. Actually, I meant the EQA for culture as a process by which we can compare results and performance of several labs during the same period of time.
I agree with you that quality assurance remain a challenge for TB laboratories and a previous step for lab accreditations.
Best regards
Gabriela Torrea
5:16 AM, 18 Mar 2009 | Permalink