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This document serves as a set of operating guidelines for ensuring quality assurance in sputum smear microscopy, part of the Tuberculosis Control Programme in Punjab, Pakistan. It covers processes
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How to fill out quality assurance in sputum

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How to fill out QUALITY ASSURANCE IN SPUTUM SMEAR MICROSCOPY

01
Gather all necessary materials, including a microscope, slides, and reagents.
02
Prepare the sputum sample by ensuring it is properly collected and stored.
03
Stain the sputum smear using appropriate staining techniques, such as Ziehl-Neelsen or auramine-rhodamine stains.
04
Allow the stained slide to dry completely before examining it under the microscope.
05
Adjust the microscope settings for optimal viewing, including lighting and focus.
06
Carefully analyze the smear for the presence of acid-fast bacilli (AFB) or other relevant microorganisms.
07
Document and report findings accurately, ensuring that all results are recorded clearly.
08
Implement regular quality control checks and participate in external quality assurance programs.

Who needs QUALITY ASSURANCE IN SPUTUM SMEAR MICROSCOPY?

01
Laboratories conducting tuberculosis diagnosis through sputum smear microscopy.
02
Healthcare professionals involved in respiratory disease management.
03
Public health organizations focusing on tuberculosis control and prevention.
04
Diagnostic centers requiring quality assurance procedures for accurate results.
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Procedure of Acid-Fast Stain Prepare bacterial smear on clean and grease free slide, using sterile technique. Allow smear to air dry and then heat fix. Alcohol-fixation: This is recommended when the smear has not been prepared from sodium hypochlorite (bleach) treated sputum and will not be stained immediately.
The AFB culture refers to the process of inoculating a clinical specimen onto culture media; including Becton-Dickinson Mycobacteria Growth Indicator Tubes (B-D MGIT broth) and a Lowenstein-Jensen (L-J) media slant. It is then incubated at 37°C for up to six weeks. Lastly, it is examined for growth or no growth.
Your health care provider will need a sample of your sputum for all AFB tests. The AFB smear and AFB culture are usually done at the same time. To get sputum samples: You will be asked to breathe deeply and then cough and spit into a sterile container.
A good smear is spread evenly over a size of 2 cm × 3 cm and is neither too thick nor too thin. This was allowed to air-dry for 15-30 min and fixed by passing it over the blue flame of the bunsen burner three to four times.
The quality of sputum samples is determined by the minimum number of squamous epithelial cells and polymorphonuclear leukocytes per low power field. An acceptable specimen has more than 25 leukocytes and fewer than 10 epithelial cells per low power field.
In this test, your sputum sample is "smeared" on a glass slide and looked at under a microscope. It can provide results in 1-2 days. These results can show a possible or likely infection but cannot be used to provide a diagnosis.
A health care provider will ask you to breathe deeply and then cough deeply into a special cup. Your provider may tap you on the chest to help loosen sputum from your lungs. If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist to help you cough more deeply.
Sputum microscopy The main limitations of smear microscopy include its low sensitivity (50–60% in most studies), inability to allow species identification and drug susceptibility testing, and inability to distinguish viable from dead bacteria while monitoring the response to treatment.

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Quality assurance in sputum smear microscopy refers to systematic processes and procedures designed to ensure that the microscopy tests for tuberculosis (TB) are performed accurately and reliably, thereby leading to correct diagnosis and appropriate treatment.
Laboratories performing sputum smear microscopy for tuberculosis diagnosis are required to file quality assurance documentation. This includes laboratory personnel, supervisors, and quality assurance officers responsible for maintaining standards.
Quality assurance forms for sputum smear microscopy must be filled out with relevant details such as the date of testing, technician's name, sample identification, results, and any deviations or corrective actions taken during the process.
The purpose of quality assurance in sputum smear microscopy is to ensure accurate and reliable test results, which helps in the early detection and treatment of tuberculosis, ultimately improving patient outcomes and public health.
Information that must be reported includes sample details (patient ID, type of specimen), technician names, date of examination, test results (positive/negative), quality control results, and any discrepancies or corrective actions taken.
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