Mulongo M, Oberlin A M, Firnhaber C, Goeieman B, Ramotshela S, Michelow P, Jordaan S, Chibwesha C J
Right to Care, Helen Joseph Hospital, Johannesburg, South Africa.
S Afr Med J. 2018 Oct 26;108(11):926-928. doi: 10.7196/SAMJ.2018.v108i11.13153.
The endocervical component of a Pap smear is an important indicator of sample quality - or 'adequacy'. However, only 6 of 52 districts in South Africa (SA) meet the Department of Health (DoH) performance benchmark: a 70% adequacy rate. We implemented a quality-improvement (QI) intervention to address suboptimal Pap smear quality in Tshwane District, Gauteng Province, SA.
To determine whether training with the wooden Ayre spatula (step 1) or introduction of the cytobroom (step 2) resulted in greater improvements in Pap smear adequacy rates.
Two Tshwane District health facilities participated in our QI project between May 2016 and February 2017. In step 1, staff received training on the Ayre spatula. In step 2, the spatula was replaced with the cytobroom. Pap smear volumes, adequacy rates and results are reported for the pre-intervention period and after each QI step. We compared adequacy rates using Fisher's exact test, with a significance level of p=0.05.
In the pre-intervention period, 304 of 965 Pap smears were deemed adequate (32%; 95% confidence interval (CI) 29 - 35%). After step 1, the proportion increased to 109 of 191 (57%; 95% CI 50 - 64%; p<0.01). Similarly, after step 2, the proportion increased to 155 of 192 (81%; 95% CI 74 - 86%; p<0.01). The proportion of abnormal smears increased from 13% before the QI intervention to 17% after step 1 and 22% after step 2.
Although training in Pap smear collection using the Ayre spatula resulted in modest improvements in quality, facilities only achieved the DoH benchmark of a 70% adequacy rate after the introduction of the cytobroom.
巴氏涂片检查中的宫颈管成分是样本质量（即“充分性”）的重要指标。然而，在南非（SA）的52个区中，只有6个区达到了卫生部（DoH）的绩效基准：充分率达到70%。我们实施了一项质量改进（QI）干预措施，以解决南非豪登省茨瓦内区巴氏涂片质量欠佳的问题。
确定使用木制艾尔刮板进行培训（步骤1）或引入细胞刷（步骤2）是否能使巴氏涂片充分率得到更大提高。
2016年5月至2017年2月期间，茨瓦内区的两家卫生机构参与了我们的QI项目。在步骤1中，工作人员接受了关于艾尔刮板的培训。在步骤2中，刮板被细胞刷取代。报告了干预前以及每个QI步骤后的巴氏涂片数量、充分率和结果。我们使用Fisher精确检验比较充分率，显著性水平为p = 0.05。
在干预前阶段，965份巴氏涂片中304份被认为是充分的（32%；95%置信区间（CI）29 - 35%）。步骤1后，这一比例增至191份中的109份（57%；95%CI 50 - 64%；p<0.01）。同样，步骤2后，这一比例增至192份中的155份（81%；95%CI 74 - 86%；p<0.01）。异常涂片的比例从QI干预前的13%增至步骤1后的17%和步骤2后的22%。
尽管使用艾尔刮板进行巴氏涂片采集培训使质量有一定提高，但在引入细胞刷后，各机构才达到卫生部70%充分率的基准。
