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Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF JAIL MANAGEMENT AND PENOLOGY
Butuan City Jail
Butuan City Jail- Health Service Unit/ TB DOTS
Libertad, Butuan City
Tel. No.: 342-9282

POLICIES AND PROCEDURE FOR ENSURING QUALITY OF


SPUTUM MICROSCOPY RESULTS

Policy Statement
The most important element in the quality of laboratory test result is its accuracy or
correctness. If the laboratory result is falsely negative, there is a chance that the patients
illness would be incorrectly diagnosed or would not be diagnosed at all. Consequences
include continued progression of the disease which would lead to its full-blown status and
eventually, death. If the disease whereof the patient is inflicted is infectious, there is a great
risk of transmission to his/her family and close contacts. On the other hand, if the result is
falsely positive, incorrect diagnosis would ensue and the patient is likely to receive
unnecessary treatment, such as therapy with toxic drugs subjecting him/her to its side effects,
even adverse effects, and hospitalization which would expose the patient to nosocomial
infections.

Purpose of the Policy


The microscopy result is used to categorize the patient by the standard definition of DOTS
(Directly Observed Treatment, Short-Course). Usually, a positive smear would indicate
presence of active tuberculosis. The result must be communicated promptly to the
supervising medical staff within the National Tuberculosis Program (NTP). Further, patients
with sputum smear-positive tuberculosis should immediately commence anti-tuberculosis
treatment because they are infectious to contacts. The initial period of treatment is usually
referred to as the intensive phase. The treatment will rapidly render the patient non-
infectious and reduce the symptoms of tuberculosis. A negative smear will usually mean that
a patient is unlikely to transmit tuberculosis to contacts. However, even with negative
sputum smear result, further tests and clinical evaluation may yield a diagnosis of sputum
smear-negative tuberculosis. Thus, the quality of DSSM is if utmost importance, since it is
the basis for the commencement of treatment and subsequent interventions.

Guidelines
In order to demonstrate and maintain high quality results, a laboratorys overall performance
should be monitored through a series of regular activities. In combination, such activities
make up the laboratorys quality assurance (QA) program, to wit:
1. Validation of samples submitted for testing;
2. Regular checking of reagents used in test procedures including expiry dates;
3. Inclusion of standards or samples of known positivity in routine test runs;
4. Periodic review and updating of procedure manuals;
5. Regular maintenance and calibration of equipment;
6. Data collection and analysis;
7. Regular meetings with clients;
8. Regular conduct of staff meeting;

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Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF JAIL MANAGEMENT AND PENOLOGY
Butuan City Jail
Butuan City Jail- Health Service Unit/ TB DOTS
Libertad, Butuan City
Tel. No.: 342-9282

9. Ensure the accuracy of laboratory results by performance of the vital technical


considerations, such as aseptic technique in the specimen collection, smearing and
staining to avoid contamination of specimen;
10. Identify any practices that are potential sources of error;
11. Ensure that appropriate corrective actions are initiated;
12. The DOTS staff at all levels must have full understanding of the many factors that
can lead to false results;
13. Ensure the accuracy of the sources of the sputum upon specimen collection by
receiving only those which are actually expectorated or coughed out by the
subject patient, which must be done in the designated coughing area and directly
observed by the DOTS Health Staff;
14. Ensure compliance of the necessary interventions in the transportation of
specimen;

Prepared by:

JO1 Reinald Raven L Guerrero, RN


Staff, Health Service Unit/ TB DOTS

Approved by:

SJO2 Florefe M Badillo, RN


Chief, Health Service Unit/ TB DOTS

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