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Module II RNTCP

LABORATORY DIAGNOSIS OF TB
&
QUALITY ASSURANCE
Dr. Rachana Vishwajeet, Dr. Neelu Gupta, Dr. Anitha AK, Dr.
Sunil Kumar, Dr. Rajesh Kumar, Dr. Arun Sinha, Dr. Shakutala
Singh, Dr. Shashi Nath
Felicitator: Dr. NEETA SINGLA

RNTCP has
separate
diagnostic
algorithm for
pediatric
pulmonary
TB and
common
forms of
extrapulmonary
TB

At least 2% of new
adult out-patients.
10-15% sputum
smear-positive
EP cases and
contacts of all
positive cases with
cough should be
subjected for
sputum
examination
irrespective of the
duration of cough.
EP TB is diagnosed
depending upon
the organ
involvement

Tools for diagnosis of Pulmonary TB in adults:


Sputum

smear microscopy

Chest

X-ray, Sputum culture and DST for diagnosis of Drug Resistant TB,
Newer rapid diagnostic tools for detection of MDR TB, Newer tools under
evaluation for diagnosis of MDR/XDR TB

Sputum smear microscopy is the primary tool for diagnosing TB as it is more


specific and has less inter and intra-reader variability than X-ray.

Two sputum smears should be examined (SpotEarly morning) for diagnosis.

Grading of smears is helpful as a quality assurance tool and monitoring

DTO and MO-TC - supporting laboratory services

STLS - supervisory activities of all the DMCs

Lab Register - record information about sputum smear results only.

Results- smear-positive results should be recorded in red ink

One Laboratory Number is given for 2 sputum examinations both for


diagnosis and follow-up examination.

FU sputum smears done at scheduled time help in monitoring


treatment

Sputum should be examined within 2 days of collection and the results


should be reported on the same day.

The health system is responsible to ensure that all diagnosed sputum


smear-positive patients are traced and put on treatment within 7 days
of diagnosis

QUALITY ASSURANCE
External Quality Assessment ((EQA)

Internal Quality Control (IQC)


1.

Its a systematic internal monitoring of working


practices

2.

It

includes

On-Site Evaluation (OSE):


Conducted at least once a month by STLS to the DMCs
Panel testing:

technical

procedures,

checking

determine whether a lab technician can adequately perform

instruments, quality of new batches of staining

AFB smear microscopy

solution, smear preparation, grading etc

evaluate individual performance in staining and reading


Random Blinded Re-Checking (RBRC) of routine

Quality Improvement (QI)


A process by which all components of smear
microscopy

diagnostic

services

are

carefully

analyzed with the aim of looking for ways to


permanently remove obstacles to success

slides:
re-reading a statistically valid sample of slides from a
laboratory to assess whether that laboratory has an acceptable
level of performance
Performed once a month for every DMCs

INFECTION CONTROL

Priority for patients with cough for early detection of smear-positive


patients

Reducing delay in starting treatment

Avoiding unnecessary admission

Reducing the risk of transmission is early diagnosis and prompt


treatment

Infectious TB patients become rapidly non-infectious once started on


DOT