1. Performance Improvement in Microbiology Laboratory
MLAB 2434 – Microbiology
Keri Brophy-Martinez

2. Terminology
“Quality Control” has always been a part of the clinical laboratory, but had been used exclusively for analytical activities. QC is designated to ensure the medical reliability of lab data.
We now know that we must analyze pre-analytical, analytical, and postanalytical activities and the terminology is NOW called “Performance Improvement” (PI)

3. Indicators/Monitors of Performance Improvement
Process Monitors
Results are complied and evaluated routinely, allows for identification of disruptions
Outcome Monitors
Measurements as a result of processes
Focus Monitors
Initiated in response to a suspected problem
Benchmarking
Seeking an industry’s or profession’s best practices
Helps provide a starting point for improvement

4. Terminology
Quality Assurance (QA) is defined as taking measures to ensure high quality patient care. Involves monitoring all parts of a system and implementing changes when suboptimal performance is identified

5. Terminology (cont’d) Preanalytical Stage Test ordering
Order transcription
Patient preparation
Specimen collection
Specimen identification
Specimen transport

6. Terminology (cont’d) Analytical Stage Postanalytical Stage
Sample testing
Postanalytical Stage
Result transcription
Result delivery
Result review
Action taken on basis of result

7. Quality Control Procedures
Daily temperature checks
NIST (National Institute of Standards & Technology)
Thermometer calibration (once when received from manufacturer)
Equipment preventive maintenance program – includes routine maintenance such as oiling, cleaning, replacing filters, etc.

8. Quality Control Procedures (cont’d)
All prepared media must be quality controlled prior to use
If media is purchased, can rely on manufacturer’s QC, but lab must obtain a statement of quality control from manufacturer
All shipments should be inspected as it comes to lab
HOWEVER, chocolate and selective agars for Neisseria and Campylobacter MUST be rechecked by lab
Test media using ATCC strains
Records maintained for 2 years
Reagents should be QC’ed on each day of use, new lot numbers, and/or with each test run

9. In-House Media QC log

10. Media Tracking Log

11. Quality Control Procedures (cont’d)
Antimicrobial Susceptibility QC
Personnel Competency – proficiency testing is one way this can be assured (CLIA requires this)
Continuing Education
QC Manual – must be reviewed and signed at least annually

12. References
Mahon, C. R., Lehman, D. C., & Manuselis, G. (2011). Textbook of Diagnostic Microbiology (4th ed.). Maryland Heights, MO: Saunders.