External Quality Assurance [EQA] for Microscopy

Ensuring accurate sputum microscopy results is paramount to maintain optimal sensitivity and specificity of sputum microscopy.

In this regard, External Quality Assurance (EQA) is an important aspect of the National TB Elimination Programme (NTEP) Laboratory Network. Different levels of EQA activities are undertaken to ensure that the system follows a standard protocol and remains efficient. The timely completion of EQA activities is important.

The EQA activities are interlinked and together (from National Reference Laboratory (NRL) to Tuberculosis Units (TUs)) give a proper output adequately ensuring accurate microscopic examination of sputum at the Designated Microscopy Centres (DMCs).

1. The EQA related activities of NRLs: This EQA ensures that the Intermediate Reference Laboratory (IRL) team maintains proficiency to carry on EQA of districts.
   1. On-site evaluation of State TB Training and Demonstration Center (STDC)/ Intermediate Reference Laboratory (IRL)
   2. Manufacture of panel testing slides and panel testing of STDC/ IRL lab staff
   3. Training of STDC supervisory staff in:
      • On-site evaluation of Senior TB Laboratory Supervisors (STLS)
      • Manufacture of panel slides
      • Assessment of blinded re-checking of DMC slides at District TB Center (DTC)
      • Facilitating the training of STLS for EQA
   4. Re-training of STDC/ IRL supervisory staff, if required
   5. Prompt reporting of the results of activities and feedback to State TB Officer/ Deputy Director General TB
2. The EQA related activities of STDC/ IRL labs: This is an ongoing process to train/retrain and maintain proficiencies of STLSs, District TB Officers (DTO) and Medical Officer - TB Control (MO-TC) to carry on EQA of DMCs.
   • Training of EQA for STLS, DTO, MO-TC
   • On-site evaluation of DTC labs and a sample DMCs
   • Manufacture of Panel testing slides and panel testing of DTC lab supervisors, including all STLS of the district
   • Re-training of DTC LT/ STLS, if required
   • Prompt reporting the results of activities by Director STDC/ IRL to STO, Central TB Division (CTD) & NRL
3. The EQA related activities of the DTC/ TB Unit: This is an ongoing monthly activity, to ensure proper proficiency of Laboratory Technicians (LTs) at DMCs to carry out sputum microscopy.
   • On-site evaluation of DMC labs
   • Unblinded re-checking of DMC slides at DMC
   • Random Blinded Re-checking (RBRC) of DMC slides at DTC
   • Prompt reporting of the results of activities to LT and Medical Officer of DMC as well as STDC/ IRL
   • Panel testing and re-training of DMC LTs, if required

Data collection, analysis and problem-solving are key components of this process.

Figure: Structure and Functions of EQA

Resources

• Training Module (1-4) for Program Managers and Medical Officer, NTEP, MoHFW, 2020.

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