Quality Improvement Strategies for Antibiotic Prescribing Sumant Ranji, M.D. February 16, 2005.
Handouts Quality Control and Quality Assurance for Antibiotic Testing
Transcript of Handouts Quality Control and Quality Assurance for Antibiotic Testing
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date zone size (mm)
23-Jan-10 23
24-Jan-10 27
25-Jan-10 26
26-Jan-10 25
27-Jan-10 25
28-Jan-10 24
29-Jan-10 24
30-Jan-10 26
31-Jan-10 271-Feb-10 29
2-Feb-10 29
3-Feb-10 23
4-Feb-10 23
5-Feb-10 22
6-Feb-10 23
7-Feb-10 238-Feb-10 22
9-Feb-10 22
10-Feb-10 23
11-Feb-10 23
12-Feb-10 22
date zone size (mm)
1-Jan-10 25
2-Jan-10 243-Jan-10 25
4-Jan-10 24
5-Jan-10 26
6-Jan-10 24
7-Jan-10 27
8-Jan-10 25
9-Jan-10 2610-Jan-10 27
11-Jan-10 27
12-Jan-10 26
13-Jan-10 28
14-Jan-10 23
15-Jan-10 24
16-Jan-10 27
17-Jan-10 26
18-Jan-10 26
19-Jan-10 28
20-Jan-10 25
21-Jan-10 25
22-Jan-10 24
Quiz: anything unusual about
QC zone sizes? QC ATCC
25923 (Saureus) with
Cefoxitin disc
(FOX)
CLSI: zone size
within 22-29mm
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Quality Control and QualityAssurance for Antibiotic Testing
22 Sep 2010
Microbiology Technical Workshop
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Introduction
Various standards
eg CLSI, CDS
Various methods
Eg disc susceptibility, microbroth dilution Follow QC instructions as stated
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Introduction (2)
Some general principles apply:
1. Materials and Procedures : strictly adhere to2. Able to detect abnormalities and take
necessary corrective actions
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Materials & Procedures
General: Expiry date & storage
conditions manufacturersrecommendation
1. Media:
sterility
Support growth
Does not interfere with activity of antibiotics
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Materials & Procedures (3)
Perform and interpret correctly
Technologists : adequately trained
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Detect Errors / Corrective actions
Documentation
Useful for monitoring / troubleshooting futureQC failures
CAP requirements
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What to do when QC is out
CLSI recommendations:
ID cause
Cause found repeat x 01
Repeat ok = case close
Repeat out of range repeat
No obvious
cause
5 consecutive days
All within range= case close
1 out ofrange
Re-examine
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Common sources of error
Media Storage
Thickness
Contamination
pH
Wrong media
Antibiotics
Storage Wrong disc
QC strains Wrong strains
Inoculum
Storage
Contamination
Old cultures
Procedures
Incubation conditions Disc placement
transcription
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Other Tools
Control charts and Westgard rules
CUSUM
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date zone size (mm)
b
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Control Chart ATCC 25923 SAU with FOX
20
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1-Ja
n-1
0
3-Ja
n-1
0
5-Ja
n-1
0
7-Ja
n-1
0
9-Ja
n-1
0
11-Jan-1
0
13-Jan-1
0
15-Jan-1
0
17-Jan-1
0
19-Jan-1
0
21-Jan-1
0
23-Jan-1
0
25-Jan-1
0
27-Jan-1
0
29-Jan-1
0
31-Jan-1
0
2-Feb-1
0
4-Feb-1
0
6-Feb-1
0
8-Feb-1
0
10-Feb-1
0
12-Feb-1
0
date
1-Feb-10 29
2-Feb-10 29
3-Feb-10 23
4-Feb-10 23
5-Feb-10 22
6-Feb-10 23
7-Feb-10 238-Feb-10 22
9-Feb-10 22
10-Feb-10 23
11-Feb-10 23
12-Feb-10 22
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Warning rules
Warning 11112SD2SD2SD2SD : It is violated if the IQC value exceeds the
mean by 2SD. It is an event likely to occur normally in less
than 5% of cases.
Warning 22222SD2SD2SD2SD : It detects systematic errors and is violatedwhen two consecutive IQC values exceed the mean on the
same side of the mean by 2SD.
Warning 44441SD1SD1SD1SD : It is violated if four consecutive IQC valuesexceed the same limit (mean 1SD) and this may indicate the
need to perform instrument maintenance or reagent
calibration.
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Mandatory rules
Mandatory 11113SD3SD3SD3SD : It is violated when the IQC value exceeds
the mean by 3SD. The assay run is regarded as out of
control.
Mandatory RRRR4SD4SD4SD4SD : It is only applied when the IQC is tested induplicate. This rule is violated when the difference in SD
between the duplicates exceeds 4SD.
Mandatory 10x10x10x10x : This rule is violated when the last 10consecutive IQC values are on the same side of the mean or
target value.
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Scenario 1
New lot / new antibiotics
How frequently should you QC?
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Scenario 2
Check
Media Antibiotics
QC organism Procedure
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Scenario 1
New antibiotic introduced
CLSI Test for 30 consecutive days
If no more 3 (out of 30) are outsideacceptable range - convert to weekly testing
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Scenario 2
7 Oct 2009 - QC ATM 20mm (expected
23-29mm) What would you do?
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Scenario 2
Repeat testing performed by same staff
Correct QC organism, media, procedure,incubation, interpretation
Wrong inoculum - too heavy
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Scenario 3
14 Oct 2008
Vitek Gram positive panel QC Multiple drugs MIC - resistant
Expected - sensitive
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Scenario 3
Purity plate - contaminated with other
organisms
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Scenario 4
QC Vitek Gram positive panel
Multiple antibiotics - resistant Expected - sensitive
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Scenario 4
Test repeated
With organism from purity plate (prev run)- resistant
And separate set from weekly QC plate -sensitive
Wrong ATCC used.
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Quality assurance
Education
External Proficiency test, eg CAP Literature and publications
Accreditation