Constantine C E, Amphlett M, Farrington M, Brown D F, Messer S, Rampling A, Warren R E
Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge.
J Clin Pathol. 1993 Nov;46(11):1046-50. doi: 10.1136/jcp.46.11.1046.
To develop an internal quality assessment (IQA) scheme in a clinical bacteriology laboratory.
Over 24 months, 1230 diagnostic specimens, representing 0.42% of laboratory workload, were anonymised and resubmitted for analysis. Six hundred and twenty one (48.7%) of these gave positive culture results; 44 fecal and upper respiratory specimens were "spiked" (artificially inoculated) to increase the proportion of positive samples.
Discrepancies between IQA and clinical sample results occurred in 188 cases (14.8%): 76.6% of these were in culture results, 13.3% in microscopy performance, and 10.1% in clerical recording. The culture discrepancy rate for each positive sample was lowest for wound (17.5%) and urine (18.1%) specimens, and highest for faeces (34.9%) and upper respiratory (37.7%) samples. Discrepancies in several areas responded to staff training and improvement in technical methods.
An IQA programme of this type assesses the reproducibility of tests within a diagnostic laboratory when analysing common specimen types and organisms. It permits blind assessment of many areas of diagnostic work that are not readily amenable to other quality assurance methods, and it raises the awareness of all staff to the importance of quality in every aspect of specimen and data processing.
在临床细菌学实验室制定一项内部质量评估（IQA）方案。
在24个月的时间里，对1230份诊断标本进行匿名处理，这些标本占实验室工作量的0.42%，然后重新提交进行分析。其中621份（48.7%）培养结果呈阳性；对44份粪便和上呼吸道标本进行“加样”（人工接种），以增加阳性样本的比例。
IQA结果与临床样本结果之间存在差异的有188例（14.8%）：其中76.6%存在于培养结果中，13.3%存在于显微镜检查结果中，10.1%存在于文书记录中。伤口标本（17.5%）和尿液标本（18.1%）中每个阳性样本的培养差异率最低，粪便标本（34.9%）和上呼吸道标本（37.7%）中最高。几个领域的差异通过工作人员培训和技术方法的改进得到了改善。
这种类型的IQA方案在分析常见标本类型和微生物时，评估诊断实验室内检测的可重复性。它允许对诊断工作中许多不易采用其他质量保证方法的领域进行盲法评估，并提高所有工作人员对标本和数据处理各个方面质量重要性的认识。
