Sputum Smear Microscopy: Evaluation of Impact of Training, Microscope Distribution, and Use of External Quality Assessment Guidelines for Resource-Poor Settings

Sputum Smear Microscopy: Evaluation of Impact of Training, Microscope Distribution, and Use of External Quality Assessment Guidelines for Resource-Poor Settings

Sputum smear microscopy is the main and often only laboratory technique used for the diagnosis of tuberculosis in resource-poor countries, making quality assurance (QA) of smear microscopy an important activity. We evaluated the effects of a 5-day refresher training course for laboratory technicians...

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Bibliographic Details
Published in:Journal of Clinical Microbiology Vol. 46; no. 3; pp. 897 - 901
Main Authors: Van Rie, A, Fitzgerald, D, Kabuya, G, Van Deun, A, Tabala, M, Jarret, N, Behets, F, Bahati, E
Format: Journal Article
Language:English
Published: Washington, DC American Society for Microbiology 01-03-2008
American Society for Microbiology (ASM)
Subjects:
Bacillus
Bacteriological Techniques
Bacteriology
Biological and medical sciences
Democratic Republic of the Congo
Fundamental and applied biological sciences. Psychology
Humans
Medical Laboratory Personnel - education
Microbiology
Microscopy - methods
Miscellaneous
Mycobacteriology and Aerobic Actinomycetes
Mycobacterium
Mycobacterium tuberculosis - isolation & purification
Poverty
Practice Guidelines as Topic - standards
Program Evaluation
Quality Assurance, Health Care
Sputum - microbiology
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - microbiology
Congo (Democratic republic)
Africa
Democratic Republic of the Congo
Technician
Staining
Laboratory staff
Optical microscopy
Microscopy
Mycobacterium tuberculosis
Mycobacteriales
Sputum
Mycobacteriaceae
Smear
Bacteria
Actinomycetes
Diagnosis
Occupational training
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Summary:Sputum smear microscopy is the main and often only laboratory technique used for the diagnosis of tuberculosis in resource-poor countries, making quality assurance (QA) of smear microscopy an important activity. We evaluated the effects of a 5-day refresher training course for laboratory technicians and the distribution of new microscopes on the quality of smear microscopy in 13 primary health care laboratories in Kinshasa, Democratic Republic of Congo. The 2002 external QA guidelines for acid-fast bacillus smear microscopy were implemented, and blinded rechecking of the slides was performed before and 9 months after the training course and microscope distribution. We observed that the on-site checklist was highly time-consuming but could be tailored to capture frequent problems. Random blinded rechecking by the lot QA system method decreased the number of slides to be reviewed. Most laboratories needed further investigation for possible unacceptable performance, even according to the least-stringent interpretation. We conclude that the 2002 external QA guidelines are feasible for implementation in resource-poor settings, that the efficiency of external QA can be increased by selecting sample size parameters and interpretation criteria that take into account the local working conditions, and that greater attention should be paid to the provision of timely feedback and correction of the causes of substandard performance at poorly performing laboratories.
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Corresponding author. Mailing address: Department of Epidemiology, 2104 McGavran Hall, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435. Phone: (919) 966-1420. Fax: (919) 966-2089. E-mail: vanrie@email.unc.edu
ISSN:0095-1137
1098-660X
1098-5530
DOI:10.1128/JCM.01553-07