Metallic taste is a minor Adverse Drug Reaction (ADR) that is observed in patients on a regimen with Ethionamide (Eto) and Fluoroquinolones (FQs). It is a non-serious ADR.

It can be easily identified by field-level health care workers and is often reported by patients on their own.

Suspected agent(s): Ethionamide (Eto), Fluoroquinolone (FQ)

Suggested Management Strategies: Encourage the patient to tolerate this side effect.

Laboratory systems and diagnosis pose several challenges in streamlining and upscaling as follows:

Workers in microbiological laboratories are not only exposed to pathogenic microorganisms, but also to chemical hazards. Therefore, knowledge of the toxic effects of these chemicals, exposure routes and hazards, that may be associated with handling and storage, is important.

A few important general safety measures against chemical exposure in laboratories are:

Liquid Culture (LC) and Line Probe Assay (LPA) specimen processing involves pre-treatment of the sputum specimens.

Digestion and decontamination are usually done using N-acetyl-l-cysteine–sodium hydroxide (NALC- NaOH) method: 

• The process is essential to free TB bacilli from the mucus cells/ tissue.
• This also helps in decontamination by killing normal flora that grows more rapidly than the TB bacilli. 

NALC-NaOH Method for Sample Processing
 

Biomedical Waste Management is an essential biosafety component of TB containment laboratories. All infectious materials should be decontaminated, incinerated, buried or autoclaved.

The following materials are suitable for waste disposal by autoclaving:

• All positive TB cultures 
• Mycobacterial cultures 
• All infectious materials from TB-containment laboratories where mycobacterial culture is performed

Sputum culture conversion - The transition in sputum culture results from a positive sample growing Mycobacterium tuberculosis to two consecutive negative cultures separated by at least 30 days.

Time to culture conversion is the interval between treatment initiation to date of specimen collection of the first (of the two) negative culture.

Disinfectants used in lab settings include:

1% Sodium Hypochlorite

• Broad spectrum antimicrobial action
• Used to disinfect surfaces
• Used to disinfect infectious material and disposal of used Truenat consumables (reagent bottles, cartridges, tips, chips) 
• Hazardous and corrosive, to be used with care
• Is highly alkaline so can corrode metal
• Waste soaked in Sodium Hypochlorite should not be discarded by autoclaving. 

70% Alcohol

Security of laboratory data and confidentiality of TB patient data are important. Hence, it is recommended to archive or take periodic data backup.

The Truelab Analyzer has an internal memory to store 20000 test results. The digital data can be transmitted through connectivity via email, SIM card, Wi-Fi or Bluetooth.

Recommended ways of documenting the results and archiving data are:

Daily maintenance of Truelab and Trueprep instruments performed by the laboratory personnel includes: