Quality Assurance in Bacteriology

Assessment of quality

Monitoring
Assessment of quality Organization of EQAS Scoring system in EQA Internal quality assessment

A. Monitoring
Objectives to confirm consistency to alert to change to assess the impact of changes to processes or procedures to identify opportunities for improvement

to provide objective measurements

Essential differences between monitoring and evaluation

B. ASSESSMENT OF QUALITY

- External or internal
External or internal Types of assessment of quality

Essential differences between monitoring and EQA

External Quality Assessment Scheme

Assessment of quality= external agency Challenges internal QC Assessed Quality of results Compares performance of different testing sites Proficiency testing

Objectives of external quality assessment scheme

Monitor laboratory performance and evaluation of quality control measures Establish inter-laboratory comparability

Influence reliability of future testing

Ensure credibility of laboratory Stimulate performance improvements

Promote high standards of good laboratory practices

 Encourage use of standard reagents/ methodology and trained personnel Identify common errors Provide mechanisms to remedy identified deficiencies Facilitate information exchange Support accreditation

Education through exercises, reports and meetings

Benefits of EQAS
Helps laboratories in comparing their results with other laboratories Acts as an educational stimulus to laboratory staff Participation provides credibility to the laboratory Helps the health administrators and regulatory agencies to have an insight into the status of quality across the country

Process of EQAS

Steps involved in EQAS

Basis of success of EQAS

Voluntary participation Confidentiality of individual reports Avoiding provocative statements about the performance Identifying unsatisfactory performers in groups or individuals Providing educational opportunities Organizer acting as adviser rather than enforcer

Comparison of performance and results Minimization of errors Self appraisal Objective evidence of quality/accreditation

Identification of training needs

Desirable features of EQAS

Clinical relevance Comprehensiveness

Versatility
Frequency of distribution Material distributed -clinical source

Availability of repeat specimens

Timeliness of feedback Availability of individual performance data

Number of participants -large enough

Independence of the scheme

Requirements of EQAS
The Material Supplied Documentation of Accompanying Material Manner of Performing the Test Number of Participating Laboratories Statistical Analysis of Results Turn-Around Time and Frequency Anonymity of Participating Laboratories

 The Material Supplied - Homogenous - One source - Stability- stated

Documentation of Accompanying Material

- Documentation + specimen - Provision= type of units - Return address, manner of returning and last date

 Manner of Performing the Test - Routine testing Number of Participating Laboratories - greater the number of participating laboratories, the greater is the usefulness Statistical Analysis of Results - Easily understood

- Results=disclosed

 Turn-Around Time and Frequency - As Short as possible - Frequency = depends on resources and feasibility Anonymity of Participating Laboratories

C. ORGANIZATION OF EQAS
Organizers Principles Selection of Laboratories and Number of Participants Identification of the Laboratories Frequency of Distribution Criteria for Assessment of Results Selection of Investigations and Help to Laboratories

 Organizers - Scientist or experts

Principles
Schemes: - specimens are sent out every month to the participants - every three or six months - check the precision only

- others check for precision and accuracy.

- send two specimens

 Selection of Laboratories and Number of Participants - All laboratories

Identification of the Laboratories

- code system Frequency of Distribution - matter of policy

 Criteria for Assessment of Results

- Clear definitions - Limits of acceptable results= percentage deviation or standard deviation - Time to analyze sample: one week - Presentation of analysis of results: clear and precise Selection of Investigations and Help to Laboratories

D. SCORING SYSTEM IN EQA

Semi-Quantitative Scoring Systems Scoring as a Stimulus to Laboratory Improvement Assessment of Progress Comparison Over Time EQAS process

 Semi-Quantitative Scoring Systems - semi-quantitative scale

- 3 point rating system

ID of unknown 2 points- correct 1 point- partially correct 0- totally wrong/failure to answer antibiotic susceptibility testing Minor error- R or S organism reported as intermediate or vice versa Major error- R to S or vice versa

 Scoring as a Stimulus to Laboratory Improvement - Scoring system= Assess performance Assessment of Progress - Comparison Over Time - A well designed scoring system should be able to delineate changes in the performance of an individual laboratory over a period of time.

 EQAS process - Forwarding an initial questionnaire - Seeking potential participants - Panel preparation - Panel distribution - Collection of results Forwarding of preliminary report - Collation and analyses of results - Communication of final report to the participant

- Recommendations
- Award of EQAS certificates

E. Internal quality assessment

Similar to EQAS Materials- prepared, distributed, evaluated and results assessed internally QA specimen= split in 2 Discrepancies = observed recorded and analyzed Suggestion of possible solutions

Applications of IQA
Assessment of variability
Statistical analysis and confidence limits on repeat testing

Assessment of effect on changes in procedures or introduction of a new technique