Proficiency Testing of Clinical Laboratories for Bacteriology in the Philippines, 2009–2015

Melisa Mondoy, Julius Matt Rapanut, Mark Philip Bugayong, Razaele Aguinaldo, Rafael Navarro, Kristine Jeanne Yap, Ma. Theresa Kapawan, Daryl Joy Almonia, Grace Esparar, Alexander Sadiasa, Noel Macalalad, Lydia Sombrero, Maria Rosario Capeding, Socorro Lupisan

Abstract

Introduction. SThe National External Quality Assessment Scheme (NEQAS) has been established by the Department of Health–Philippines (DOH) to provide DOH-approved external quality assessment programs, including the Proficiency Test (PT) for Bacteriology to clinical laboratories. The PT for Bacteriology aims to monitor and evaluate laboratory capabilities in the identification of clinically important pathogens through proficiency testing. Since then, participation in the NEQAS has been a requirement for clinical laboratories to obtain a license to operate from the DOH–Health Facilities and Services Regulatory Bureau (HFSRB).

Objective. The objective of this report is to summarize and examine the results of the PT for Bacteriology from 2009 to 2015 and the performances of participating clinical laboratories throughout the Philippines.

Methodology. The Research Institute for Tropical Medicine National Reference Laboratory (RITM-NRL) conducted orientation seminars between 2008 and 2009 to introduce clinical laboratories to the NEQAS. Laboratories submitted their accomplished enrolment forms to RITM–NRL and paid the fees to enroll in the PT. Participating laboratories were required to identify three analytes and perform antimicrobial susceptibility test (AST) on one assigned analyte.

Results. A total of 468 laboratories participated over the seven-year period. The number of participating laboratories obtaining a passing score of 80% and above had significantly increased from 2009 to 2015. Out of the 144 laboratories consistently enrolled over the seven-year period, the proportion of participants with scores of 80% and above had increased. Of the 468 participating laboratories throughout 2009 to 2015, 33.3% were good performers; 6.6% were fair performers; and 60.0% were poor performers.

Conclusion. The increasing number of participating laboratories obtaining passing scores over the years suggests overall improvement of the performance of clinical laboratories in bacteriology. Corrective actions are still needed to address the situation regarding the poor performing laboratories. The assessments done in 2008 and 2013 found that poorly performing laboratories lack trained personnel, resources, and implementation of quality assurance procedures for bacteriological testing.

Keywords

laboratory proficiency testing, bacterial identification, antibiotic susceptibility testing

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References

Stang HL, Anderson NL. Use of proficiency testing as a tool to improve quality in microbiology laboratories. Clin Microbiol Newsl. 2013;35(18):145-52. PMCID: PMC4696484. NIHMSID: NIHMS742893. https://doi.org/10.1016/j.clinmicnews.2013.08.007.

WHO Southeast Asian Regional Office. Quality assurance in bacteriology and immunology. New Delhi: World Health Organization, 2012. http://apps.searo.who.int/PDS_DOCS/B4871.pdf?ua=1.

Jones RN, Glick T, Sader HS, et al. Educational antimicrobial susceptibility testing as a critical component of microbiology laboratory proficiency programs: American Proficiency Institute results for 2007–2011. Diagn Microbiol Infect Dis. 2013;75(4):357-60. PMID: 23481025. https://doi.org/10.1016/j.diagmicrobio.2013.01.027.

Snell JJ, De Mello JV, Gardner PS. The United Kingdom national microbiological quality assessment scheme. J Clin Pathol. 1982;35(1):82-93. PMID: 7061722. PMCID: PMC497453.

Whitby JL, Black WA, Richardson H, Wood DE. System for laboratory proficiency testing in bacteriology: organisation and impact on microbiology laboratories in health care facilities funded by the Ontario Government. J Clin Pathol. 1982;35(1):94-100. PMID: 7061723. PMCID: PMC497454.

Kumasaka K, Kawano K, Yamaguchi K, et al. A study of quality assessment in clinical microbiology performance of independent laboratories in Tokyo: 18-year participation in the Tokyo Metropolitan Government External Quality Assessment Program. J Infect Chemother. 2001(2);7:102-9. PMID: 11455500. https://doi.org/10.1007/s1015610070102.

Siegrist HH, Pünter-Streit V, von Graevenitz A. The Swiss External Quality Assessment Scheme in Bacteriology and Mycology 1992-1996. Accreditation Qual Assur. 1998;3(5):203-07.

Frean J, Perovic O, Fensham V, et al. External quality assessment of national public health laboratories in Africa, 2002–2009. Bull World Health Organ. 2012(3);90:191-9A. PMCID: PMC3314205. https://doi.org/ 10.2471/BLT.11.091876.

Snell JJS. Problems in susceptibility testings—findings of UK NEQAS for microbiology. J Antimicrob Chemother. 1994;33:1-4. https://academic.oup.com/jac/article/33/1/1/717194.

Romualdez A. Department Order No. 393-E s. 2000: Designation of National Reference Laboratories and transfer of corresponding equipment, instruments, supplies, specimens, records from the Bureau of Research and Laboratories to the designated National Reference Laboratories. November 2000. http://lcp.gov.ph/images/Dept_Order_393E_s2000.pdf.

Duque F. Administrative Order No. 2007-0027: Revised rules and regulations governing the licensure and regulation of clinical laboratories in the Philippines. August 2007.

Duque F. Department Memorandum No. 2009-0086: Implementation of External Quality Assessment Program as a regulatory requirement for licensing of clinical laboratories. February 2009.

Lutero N. Department Memorandum No. 2009-0086-B: Amendment to Department Memorandum No. 2009-0086-A entitled, “Implementation of External Quality Assessment Program as regulatory requirement for licensing of clinical laboratories.” September 2014. http://lcp.gov.ph/images/Dept_Memo_2009_0086B.pdf.

O’Brien KL, Bronsdon MA, Dagan R, et al. Evaluation of a medium (STGG) for transport and optimal recovery of streptococcus pneumoniae from nasopharyngeal secretions collected during field studies. J Clin Microbiol. 2001;39(3):1021-4. PMID: 11230421. PMCID: PMC87867. https://doi.org/10.1128/JCM.39.3.1021-1024.2001.

Pfaller MA, Richter SS, Funke G, et al., eds. Manual of Clinical Microbiology, 11th Edition. American Society of Microbiology, 2015.

Atlas RM, Snyder JW. Handbook of media for clinical and public health microbiology. Boca Raton: CRC Press, Taylor and Francis Group, 2014.

Patel JB, Weinstein MP, Eliopoulos GM, et al. Performance standards for antimicrobial susceptibility testing. 27th ed. Clinical and Laboratory Standards Institute, 2017.

Dangerous goods regulations (iata--resolution 618 attachment “a”): effective 1 January-31 December 2015. Montreal: Intl Air Transport Assn, 2014.

Chosewood LC, Wilson DE, eds. Biosafety in microbiological and biomedical laboratories. 5th ed. Washington: U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention National Institutes of Health, 2010.

Droettboom M, Caswell TA, Hunter J, et al. Matplotlib/Matplotlib: V2.0.0. January 2017.

Jones E, Oliphant T, Peterson P, et al. SciPy: Open Source Scientific Tools for Python. 2001.

Rodriguez-Fdez I, Canosa A, Mucientes M, Bugarin A. STAC: A web platform for the comparison of algorithms using statistical tests. In: IEEE; 2015:1-8.

Castillo D, Harcourt B, Hatcher C, et al. Laboratory Methods for the Diagnosis of Meningitis Caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenza, 2nd ed. Geneva, Switzerland: World Health Organisation Press, 2011.

Barbé B, Yansouni CP, Affolabi D, Jacobs J. Implementation of quality management for clinical bacteriology in low-resource settings. Clin Microbiol Infect. 2017;23:426-33. PMID: 28506781. https://doi.org/10.1016/j.cmi.2017.05.007.

Ehrmeyer SS, Laessig RH. Has compliance with CLIA requirements really improved quality in US clinical laboratories? Clin Chim Acta. 2004;346(1):37-43. PMID: 15234634. https://doi.org/10.1016/j.cccn.2003.12.033.

Crucitti T. National External Quality Assessment Schemes for microbiology, parasitology, and virology in Europe. Accreditation Qual Assur. 2001;6(8):379-81.

Libeer JC. Role of external quality assurance schemes in assessing and improving quality in medical laboratories. Clin Chim Acta. 2001;309(2):173-7. PMID: 11438297.

Noble MA. Advances in microbiology EQA. Accreditation Qual Assur. 2002;7(8-9):341-4.

Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002;50(4):243-60. PMID: 12014897. https://doi.org/10.1053/jhin.2001.1151.

van Belkum A, Dunne WM. Next-Generation Antimicrobial Susceptibility Testing. J Clin Microbiol. 2013;51(7):2018-24. PMID: 23486706. PMCID: PMC3697721. https://doi.org/10.1128/JCM.00313-13.

Kiska DL, Kerr A, Jones MC, et al. Accuracy of four commercial systems for identification of Burkholderia cepacia and other gram-negative nonfermenting bacilli recovered from patients with cystic fibrosis. J Clin Microbiol. 1996;34(4):886-91. PMID: 8815102. PMCID: PMC228911.

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