Performance Improvement in Microbiology Laboratory

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Performance Improvement in Microbiology Laboratory

• MLAB 2434 Microbiology
• Keri Brophy-Martinez

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Terminology

• Quality Control has always been a part of the
  clinical laboratory, but had been used
  exclusively for analytical activities. QC is
  designated to ensure the medical reliability of
  lab data.
• We now know that we must analyze pre-analytical,
  analytical, and postanalytical activities and the
  terminology is NOW called Performance
  Improvement (PI)

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Indicators/Monitors of Performance Improvement

• Process Monitors
• Results are complied and evaluated routinely,
  allows for identification of disruptions
• Outcome Monitors
• Measurements as a result of processes
• Focus Monitors
• Initiated in response to a suspected problem
• Benchmarking
• Seeking an industrys or professions best
  practices
• Helps provide a starting point for improvement

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Terminology

• Quality Assurance (QA) is defined as taking
  measures to ensure high quality patient care.
  Involves monitoring all parts of a system and
  implementing changes when suboptimal performance
  is identified

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Terminology (contd)

• Preanalytical Stage
• Test ordering
• Order transcription
• Patient preparation
• Specimen collection
• Specimen identification
• Specimen transport

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Terminology (contd)

• Analytical Stage
• Sample testing
• Postanalytical Stage
• Result transcription
• Result delivery
• Result review
• Action taken on basis of result

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Quality Control Procedures

• Daily temperature checks
• NIST (National Institute of Standards
  Technology)
• Thermometer calibration (once when received from
  manufacturer)
• Equipment preventive maintenance program
  includes routine maintenance such as oiling,
  cleaning, replacing filters, etc.

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Quality Control Procedures (contd)

• All prepared media must be quality controlled
  prior to use
• If media is purchased, can rely on manufacturers
  QC, but lab must obtain a statement of quality
  control from manufacturer
• All shipments should be inspected as it comes to
  lab
• HOWEVER, chocolate and selective agars for
  Neisseria and Campylobacter MUST be rechecked by
  lab
• Test media using ATCC strains
• Records maintained for 2 years
• Reagents should be QCed on each day of use, new
  lot numbers, and/or with each test run

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In-House Media QC log
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Media Tracking Log
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Quality Control Procedures (contd)

• Antimicrobial Susceptibility QC
• Personnel Competency proficiency testing is one
  way this can be assured (CLIA requires this)
• Continuing Education
• QC Manual must be reviewed and signed at least
  annually

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References

• Mahon, C. R., Lehman, D. C., Manuselis, G.
  (2011). Textbook of Diagnostic Microbiology (4th
  ed.). Maryland Heights, MO Saunders.