Published on LMS

A field visit is an ideal way to obtain a realistic assessment of the conditions and skills practiced in the laboratory. Under National TB Elimination Programme (NTEP), On-site Evaluation (OSE) of Intermediate Reference Laboratories (IRLs) and District TB Centres (DTCs)/ Designated Microscopy Centres (DMCs) is therefore an essential component of a meaningful Quality Assurance (QA) programme.

Panel testing is a method of External Quality Assurance (EQA) that is used to determine the adequacy of a laboratory technician to perform Acid-fast Bacillus (AFB) smear microscopy. This method evaluates individual performance in staining and reading and not the other laboratory activities.

Quality Assurance (QA) is a systematic process used to determine the quality standards of TB laboratories.

Poor quality diagnosis may results in failure to diagnose TB or unnecessary treatment of non-TB case. Thus an effective QA mechanism is important for reliability of laboratory diagnosis.

QA in National Tuberculosis Elimination Programme (NTEP) consists of:

The administrative measures at a health care facility play an important role in preventing the spread of TB in health care settings. It includes Administrative controls for outpatient and inpatient settings

Administrative measures at Outpatient(OPD) settings
1. Screen for respiratory symptoms as early as possible upon patient’s arrival at the health care facility thereby reducing the overall stay of such patients in the healthcare facility

Ventilation is defined as the supply/ distribution/ exchange or removal of air from spaces by mechanical or natural means.

Mycobacterium tuberculosis is transmitted in airborne particles called droplet nuclei that are expelled when a person with pulmonary TB coughs, sneezes, shouts, or sings. People nearby may breathe in these bacteria and become infected. 

Airborne infection control is essential to prevent the spread of TB within a health facility and other settings.

Hierarchy of Controls to Reduce Risk of Transmission of TB (see the Figure)

The Medical Officer (MO) of Designated Microscopy Centre (DMC) is responsible for determining the amount of reagents and other materials the DMC needs every month.

The Senior TB Laboratory Supervisor (STLS) will make sure these supplies are distributed in a timely manner, usually on a monthly basis or as and when required.

After air drying and heat-fixing of the smear, it needs to be stained.

Fluorescence microscopy (FM) staining should always be carried out in a designated area. The reagents required for the FM staining procedure are shown in Figure 1. The steps involved in the staining procedure are shown in Figure 2.

Figure 1: Reagents Required for FM Staining

Results of Ziehl–Neelsen (ZN) and Fluorescence Microscopy (FM) are added to Nikshay Diagnostic Module. After a patient is registered, test details are added which then leads to the page to add details on sample type, facility and test results (Figures 1-6).

Features of Nikshay Diagnostic Module

After air drying and heat-fixing of the smear, it needs to be stained for the identification of MTB during microscopy.

The reagents required for the ZN staining procedure are shown in Figure 1. The steps involved in the staining procedure are shown in Figure 2.

Figure 1: Reagents Required for ZN Staining