1. TB Bacteriology Workshop � The Way Forward� Quality Assurance Plans

2. Role in HIV Care and Treatment Role for quality control of microbiology and susceptibility test procedures Use of gram stain on proper specimens for rapid diagnosis in case of meningitis, septicemia Quality control of culture techniques. Documentation of QC media prepared within each lab where cultures are performed.

3. Specimen Transport Use of CPC for specimens from long distances Transport from HC to District and Province From Province to CDL for culture

4. Decontamination of Specimens  Monitor the number of isolates which grow compared to the number of smear positive and smear negative specimens Smear positive specimens- highly smear positive should expect growth Smear negative specimens- even some smear negative should grow in culture

5. Zeihl Neelsen Stain Perform positive and negative quality control strains- when stain reagents are prepared. Record results of control slides include date of preparation of each reagent. How often are QC srains performed after initial stain has been made? Performed daily or weekly?

6. Zeihl Neelsen Cont�d When experienced staff are performing ZN, QC slides should be performed with each stain. What are the benefits for this? Results of quality control should be recorded on a separate QC log.

7. Auramine-O Stain Perform QC slides each time smears are stained Record results on a separate log for A-O stain Log the time when the FA scope is turned on and turned off even though there is a monitor on the scope Monitor the quality of reading of AFB smears by AO with ZN or either by having a sample screened by re-staining with A-O stain. Closely monitor results of A-O staining to confirm the accuracy of results with data for publication to IUATLD/WHO

8. QC Smear Results Perform QC using a smear positive patient sputum to confirm that decontamination procedure is working ie that AFB are not being killed � should grow on L-J or MGIT

9. Bacteriology QC Sensitivity Use standard quality control strains for each type of antibiotics, GN and GP Use of antibiotics in hospital formularly Meet with Pharmacy, Infection Control and Physicians on interpretation of antibiotic results provided in the laboratory Test proper antibiotic for the type of organism and specimen from which the isolate was taken.

10. Culture and Identification Media Confirm sterility before media is placed into use Confirm media is working properly with positive and negative control organisms Record date, lot number of medium or ingredient used as well as results for each batch of media prepared. Compare growth on culture media to what was observed on the direct gram stain of the clinical specimen Confirm the gram stain of isolate prior to antibiotic susceptibility testing and performing biochemical reactions

11. Quality Assurance Intra-laboratory reproducibility How well results agreement among technicians within the same laboratory Inter-laboratory reproducibility How well results agree among different labs within the country Correlation of laboratory results- smear vs culture

12. How Do We Measure Progress What shall we report to the National Level? What should the National Level report to the Provinces, Districts? How often shall we report Why should we report? Advantages and disadvantages of reporting

13. Should We Fly With Eagles? Or stay on the roost???