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SUDAN-NTP Microscopy network and AFB quality assurance

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SUDAN-NTP Microscopy network and AFB quality assurance

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    1. SUDAN-NTP Microscopy network and AFB quality assurance Overview of Sudan-NTP microscopy network 2. Quality assurance on Sudan-microscopy network.

    2. Sudan NTP Microscopy network One TB National Reference lab. 22 State TB Reference lab. 297 peripheral TB laboratories.

    3. Laboratory workload in 11 states 2002 Average Slide Positivity = rate 10% Average workload = 2000Average workload = No of slides done/ No of laboratories

    4. Tasks of TB National Reference Lab:- 1- Maintaining high proficiency in routine smears microscopy carried out at peripheral health facilities. 2- Training of laboratory staff involved in the national laboratory network for tuberculosis. 3- Surveillance of anti-tuberculosis drug resistance. 4- Collaboration in research activities.

    5. Tasks of State TB Reference Lab:- 1- Preparation and distribution of the stains to peripheral laboratories in the state. 3- Training of local lab.assistant. 4- Supervision activities. 5- Implementation and follow up of the Quality Assurance of sputum microscopy.

    6. Tasks of peripheral TB Laboratory:- 1- Examination of sputum smears by Z.N technique . 2- Registration of results in lab register book. 3- Keep slides for E.QC.

    7. Organogram of Sudan NTP network

    8. Supervision:- Supervision is a key element of TB control and is considered the corner stone for sustainability of different NTP activities. Effective supervision will ensure sustainable,high quality services. Supervision can also be seen as a tool to achieve the NTP objectives.

    9. The specific objectives of supervision in the NTP laboratory network Provide support to health staff in order to improve their skills and performance. Monitor the implementation of NTP activities. Ensure high quality performance. Help solve problems related to sputum microscopy. Provide on job training. Share ideas.

    10. Levels of supervision The NTP carries out supervision at the following four levels. 1- Central level. 2- State level. 3- province level. 4- Microscopy centers.

    11. The Frequency of supervision is done as TCU St (Once per year) St.C Pr.C (Quarterly) Pr.C TBMU (Monthly) Regular supervision is vital to NTP success.Feedback between different levels of the NTP is necessary to maintain staff motivation and quality of services.

    12. Training 1- To train and retrain lab staff on sputum microscopy. 2- To implement new technique. 3- To exchange the experience between different levels.

    13. Levels of Training :- 1- International level: sending local NTP staff to attend external courses or workshops. inviting external expertise to carry out workshops to NTP staff in the Sudan. 2- National level: (SNTBRL). 3- State level: (state team in target states).

    14. Quality Assurance System

    15. Definition of Quality Assurance It is a system designed to continuously improve the reliability and efficiency of laboratory services.(WHO-IUATLD). A quality assurance program for AFB smear microscopy has several components.

    16. Objectives of External Quality Assurance by blind rechecking Quality Control of routine smears. Continuous motivation and education. Improve quality by screening for unaccepted performance and problem solving. Complementary to on-site evaluation.

    17. NTP LABORATORY QUALITY ASSURANCE System

    18. Q.A system in Sudan NTP In last five year the SNRL collect 100% (all) positive slide and 10% from negative slide then all slides rechecked again by SNRL staff . Now the SNTP implemented QA system by Blind Rechecking of slides

    19. Steps of E.QA by Blind Rechecking of Slides 1.Slides keeping:- Keep all slides whatever the result (representative) Each slide must be identified by number of slide and number of patient as obtained in the lab register book of TBMU. No result must be appear on slides (Blindness). Slides should be kept according to their number. Once a sample was collected, the remaining slides should be discarded

    20. 2. Taking a sample(I) (State QCC Quarterly from slides of previous quarter Sample(random) size is a fixed number, according to LOTS quality assurance sampling technique it depends on frequency of smear negative and slides positivity rate First identify sample slides in lab register book: start with a random number each time Use the master form(form1) to list these slides identification numbers(ID) and their results and make another copy without results.

    21. 2. Taking a sample(II) (State QCC) Collect slides from the slide boxes, mark missing slides as such in the remarks column and replace them by the next slide Arrange slides in the transportation box according to their ID Bring slides to state lab. Coordinator with a copy of master form without results

    22. 3. Blind rechecking (state lab.coordinator -first controller) Should clean all slides with Xylene Restaining to all selected slides Recheck all selected slides, reviewing the same number of fields as should have been done in the TBMU List the results on the master form and gives results to state quality control officer.

    23. 4. Identification of discordants (State QCC) Add state TB lab coordinator results to form 2, and compare with TBMU results using the errors cross-table Identify all slides with discordant results Make a list of those per TBMU on the discordants form, alternating column from time to time ( so part of TBMU and part of state TB lab coordinator results in each of the first two columns) Request these slides from the state TB lab, and send them to National TB reference lab together with the discordants list(form 3)

    24. 5. National reference laboratory ( second controller) Controller are given slides plus discordants list to guide their work; these controllers must have plenty of time All discordant slides must first restained Readings should then be added to discordants list(form3) and then returned to each state with the slides.

    26. 7.Quarterly feedback to TBMU (State QCC) Send to TBMU a copy of (form2) together with slides with serious errors for review. No Error of any type optimal performance . Major Error : HFP or HFN Unacceptable Performance (Evaluation and Corrective Action) . Minor Errors : Quantification errors , LFP or LFN should not exceed predetermined level.

    28. Obstacles:- 1- Labeling and keeping of slides. 2- Collection of slides from TBMU. 3- Sending of discordant slides from states to NRL.

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