Role of STLS at a TDC

The Senior TB Laboratory Supervisor (STLS) is the person responsible for monitoring the day-to-day activities of all the microscopy centres and nucleic acid amplification test (NAAT) sites and is thus essential to the success of the National TB Elimination Programme (NTEP). They also ensure the quality of TB diagnostic services.

Roles of STLS at the DMC

1. Program management

The STLS is responsible for ensuring that microscopy services in the district are well organized and the locations of all the TB Detection centres (TDCs) are known to all the medical officers in all peripheral health institutions (MO-PHI).

The STLS also ensures that there are:

• Uninterrupted staffing of TDCs, including coverage for laboratory technicians (LTs) that might be on leave, so that there is regular and uninterrupted availability of TB testing services at the.
• Uninterrupted supply of reagents and logistics required for the microscopy.
• Quality assurance and accuracy guarantee for the microscopic activities carried out.
• Regular training and continuing education of LTs.

The STLS reports to the district TB officer (DTO) in collaboration with the senior treatment supervisor (STS) regarding implementation, quality control (QC), supervision and management of laboratory supplies.

2. Monitor documentation related to microscopy

STLS ensures that all documentation related to sputum smear examinations is accurate and reports of examinations are given to the treating physician promptly. This includes:

• Each LT has a TB lab register which is filled completely and accurately.
• LTs understand the importance of limiting administrative errors (for example, keeping the sputum specimens with the proper lab forms for sputum examination and slides) and accurately recording the results of sputum smear examinations.
• LTs keep examined slides for review and on-site evaluation (OSE) visit by the STLS.
• There is an accurate recording of the results of the sputum smear examination.

STLS must explain to LTs that patients are diagnosed and placed on appropriate treatment regimens based on the smear results.

3. Ensure appropriate number and schedule of sputum examinations

• Presumptive TB persons should have their sputum examined the correct number of times for tubercle bacilli, at least 2 sputum samples should be examined.
• Follow-up cases should have 2 sputum samples examined and should be done according to the follow-up schedule.
   

4. Perform laboratory QC

This is done via OSE visits. The visit includes a comprehensive assessment of the laboratory safety including infection control measures; conditions of the equipment, adequacy of supplies as well as the technical components of acid-fast bacilli (AFB) smear microscopy employing a simple “Yes” and “No” checklist.

• The STLS visits every DMC under their supervision at least once every 4 weeks, and more often if possible.
• During these visits, at least 5 positive and 5 negative slides must be re-checked by the STLS.
• Staff at the DMC is supervised, evaluated and trained during these visits.
• The STLS maintains a diary, recording the details of these field visits.

At the end of each QC visit, detailed feedback is given by the STLS for continuous internal quality improvements. The STLS also ensures that centres maintain proper storage and transport of sputum specimens, the safety of lab staff and the maintenance of microscopes.

5. Waste disposal checks: STLS ensures that contaminated material is disposed of safely to ensure infection control. Sputum containers with sputum must either be incinerated, disinfected and autoclaved, or burnt in a pit and the burnt material buried.

6. Maintain an adequate supply of all materials necessary for microscopic examination

The STLS ensures that LTs have an adequate supply of reagents, sputum containers, slides and other materials including boxes for storing slides. This includes:

• Calculating the required volume of material (slides, sputum containers, etc.) required.
• Ordering supplies during the first week of the quarter to ensure uninterrupted supply at all DMCs.
• Distribution of sputum containers to all sputum collection centres/ DMCs in the area.
• Estimating and ensuring maintenance of adequate reserve stock at DMCs.

Resources

• NTEP Training Modules 1-4 for Programme Managers & Medical Officers, 2020.
• Module for Senior Tuberculosis Laboratory Supervisors, NTEP, 1999.
• Module for Laboratory Technicians, NTEP, 2005.

Assessment