Research Article| Volume 16, ISSUE 3, P657-675, September 1996

Quality Assurance in the Mycobacteriology Laboratory: Quality Control, Quality Improvement, and Proficiency Testing

  • Gail L. Woods
    Address reprint requests to: Gail L. Woods, MD, Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0740
    Clinical Microbiology Laboratory, Department of Pathology, University of Texas Medical Branch, Galveston, Texas
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  • John C. Ridderhof
    Division of Laboratory Systems Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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      This paper is only available as a PDF. To read, Please Download here.
      The components of quality assurance in the mycobacteriology laboratory—quality control, quality improvement, and proficiency testing—address not only the accuracy of testing but also provide a measure for the laboratory practices that are necessary to diagnose and control tuberculosis in the community effectively. Laboratories should use the recommendations concerning turnaround times as either achievable goals or as a measure of whether the laboratory should be performing mycobacteriology tests. The authors strongly urge laboratories to include their turnaround times for results and the timeliness of reporting those results in their annual quality assurance program.
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        • Abe C.
        • Hosojima S.
        • Fukasawa Y.
        • et al.
        Comparison of MB-Check, BACTEC, and egg-based media for recovery of mycobacteria.
        J Clin Microbiol. 1992; 30: 878-881
        • Aber V.R.
        • Allen B.W.
        • Mitchison D.A.
        • et al.
        Quality control in tuberculosis bacteriology. Laboratory studies on isolated positive cultures and the efficiency of direct smear examination.
        Tubercle. 1980; 61: 123-133
        • Albright Jr, RE
        • Graham III, CB
        • Christenson R.H.
        • et al.
        Issues in cerebrospinal fluid management. Acid-fast bacillus smear and culture.
        Am J Clin Pathol. 1991; 95: 418-423
        • Anargyros P.
        • Astill D.S.
        • Lim I.S.
        Comparison of improved BACTEC and Lowenstein-Jensen media for culture of mycobacteria from clinical specimens.
        J Clin Microbiol. 1990; 28: 1288-1291
        • Butler W.R.
        • Warren N.G.
        • Kubica G.P.
        • et al.
        Modified method for testing the quality of albumin-containing enrichments used in growth media for mycobacteria.
        J Clin Microbiol. 1990; 28: 1068-1070
        • Centers for Disease Control and Prevention
        Laboratory practices for diagnosis of tuberculosis—United States, 1994.
        MMWR. 1995; 44: 587-590
        • Clarridge J.E.
        • Rambo C.
        • Desmond E.
        • et al.
        Subtle medium variations affect results [letter].
        ASM News. 1995; 61: 270-271
      1. Clinical Microbiology Procedures Handbook: Mycobacteriology. Washington, DC, American Society for Microbiology, 1992, pp 3.0.1-3.16.3

      2. College of American Pathologists: Mycobacteriology. Commission on Laboratory Accreditation Inspection Checklist. Northfield, IL, College of American Pathologists. 1995, pp 29-38

        • Conville P.S.
        • Witebsky F.G.
        Inter-bottle transfer of mycobacteria by the BACTEC 460.
        Diagn Microbiol Infect Dis. 1989; 12: 401-405
        • Dizon D.
        • Mihailescu C.
        • Bae H.C.
        Simple procedure for detection of Mycobacterium gordonae in water causing false-positive acid-fast smears.
        J Clin Microbiol. 1976; 3: 211
      3. Gross W, Desmond D, Salfinger M, et al: Method for preventing, recognizing and dealing with cross-contamination in the mycobacteriology laboratory. Proceedings of the Second National Conference on Laboratory Aspects of Tuberculosis. Atlanta, April 27, 1995, Association of State and Territorial Public Health Laboratory Directors, p 95

        • Guthertz L.S.
        • Griffith M.E.
        • Ford E.G.
        • et al.
        Quality control of individual components used in Middlebrook 7H10 medium for mycobacterial susceptibility testing.
        J Clin Microbiol. 1988; 26: 2338-2342
        • Havlik D.
        • Woods G.L.
        Screening sputum specimens for mycobacterial culture.
        Lab Med. 1995; 26: 411-413
        • Hawkins J.E.
        • Good R.C.
        • Kubica G.P.
        • et al.
        Levels of laboratory services for mycobacterial diseases.
        Am Rev Respir Dis. 1983; 128: 213
        • Hewlett D.
        • Horn D.L.
        • Alfalla C.
        Drug-resistant tuberculosis: Inconsistent results of pyrazinamide susceptibility testing [letter]. Salfinger M [reply].
        JAMA. 1995; 273: 916-917
        • HPLC and Mycobacterium
        The Dynamic Duo. A Symposium on the Use of HPLC in the TB Laboratory. National Laboratory Training Network, Atlanta1995
        • Inderlied C.B.
        • Salfinger M.
        Antimicrobial agents and susceptibility tests: mycobacteria.
        in: Murray PR Baron EJ Pfaller MA Manual of Clinical Microbiology. ed 6. American Society for Microbiology, Washington, DC1995: 1385-1404
        • Jones W.D.
        Bacteriophage typing of Mycobacterium tuberculosis cultures from incidents of suspected laboratory cross-contamination.
        Tubercle. 1988; 69: 43-46
        • Kent P.T.
        • Kubica G.P.
        Public health mycobacteriology: A guide for the level III laboratory. Centers for Disease Control, Atlanta1985
        • Kramer F.
        • Modilevsky T.
        • Valiany A.R.
        • et al.
        Delayed diagnosis of pulmonary tuberculosis in patients with human immunodeficiency virus infection.
        Am J Med. 1990; 89: 451-456
        • MacGregor R.R.
        • Clark L.W.
        • Bass F.
        The significance of isolating low numbers of Mycobacterium tuberculosis in culture of sputum specimens.
        Chest. 1975; 68: 518-523
        • Mathur P.
        • Sacks L.
        • Auten G.
        • et al.
        Delayed diagnosis of pulmonary tuberculosis in city hospitals.
        Arch Intern Med. 1994; 154: 306-310
        • Maurer J.R.
        • Desmond E.P.
        • Lesser M.D.
        • et al.
        False-positive cultures of Mycobacterium tuberculosis.
        Chest. 1984; 86: 439-443
        • McCarter Y.S.
        • Robinson A.
        Detection of acid-fast bacilli in concentrated primary specimen smears stained with rhodamine-auramine at room temperature and at 37°C.
        J Clin Microbiol. 1994; 32: 2487-2489
        • Mitchison D.A.
        • Keyes A.B.
        • Edwards E.A.
        • et al.
        Quality control in tuberculosis bacteriology. The origin of isolated positive cultures from the sputum of patients in four studies of short course chemotherapy in Africa.
        Tubercle. 1980; 61: 135-144
        • Murray P.R.
        Mycobacterial cross-contamination with the modified BACTEC 460 TB system.
        Diagn Microbiol Infect Dis. 1991; 14: 33-35
      4. Mycobacterium tuberculosis: Assessing Your Laboratory. Association of State and Territorial Public Health Laboratory Directors and US Dept of Health and Human Services. Atlanta, Centers for Disease Control and Prevention, 1995

      5. National Committee for Clinical Laboratory Standards: Quality assurance for commercially prepared microbiologic culture media. Approved standard M22-A, Villanova, PA, National Committee for Clinical Laboratory Standards, 1990

        • Nolte F.S.
        • Metchock B.
        in: Murray PR Baron EJ Pfaller MA Manual of Clinical Microbiology. ed 6. American Society for Microbiology, Washington, DC1995: 400
        • Noordhoek G.T.
        • Kolk A.H.D.
        • Bjune G.
        • et al.
        Sensitivity and specificity of PCR for detection of Mycobacterium tuberculosis: A blind comparison study among seven laboratories.
        J Clin Microbiol. 1994; 32: 277-284
        • Patterson J.E.
        • Chapin-Robertson K.
        • Waycott S.
        • et al.
        Pseudoepidemic of Nocardia aster-oides associated with a mycobacterial culture system.
        J Clin Microbiol. 1992; 30: 1357-1360
        • Rickman T.W.
        • Moyer N.P.
        Increased sensitivity of acid-fast smears.
        J Clin Microbiol. 1980; 11: 618-620
      6. Schifman RB, Valenstein PN: Laboratory diagnosis of tuberculosis: Data analysis and critique. Q-Probes. College of American Pathologists, 1995

        • Sewell D.L.
        • Schifman R.B.
        Quality assurance: Quality improvement, quality control, and test validation.
        in: Murray PR Baron EJ Pfaller MA Manual of Clinical Microbiology. ed 6. American Society of Microbiology, Washington, DC1995: 55
        • Siddiqi S.H.
        • Mertz D.R.
        • Stacey R.L.
        Manufacturer investigates medium performance, [letter].
        ASM News. 1995; 61: 499-500
        • Small P.M.
        • McClenny N.B.
        • Singh S.P.
        • et al.
        Molecular strain typing of Mycobacterium tuberculosis to confirm cross-contamination in the mycobacteriology laboratory and modification of procedures to minimize occurrence of false-positive cultures.
        J Clin Microbiol. 1993; 31: 1677-1682
        • Smith W.B.
        • Vance D.W.
        Specimen cross-contamination by a strain of Mycobacterium tuberculosis lacking nitrate reductase activity.
        Diagn Microbiol Infect Dis. 1991; 14: 523-526
        • Stager C.E.
        • Libonati J.P.
        • Siddiqi S.H.
        • et al.
        Role of solid media when used in conjunction with the BACTEC system for mycobacterial isolation and identification.
        J Clin Microbiol. 1991; 29: 154-157
        • Tenover F.C.
        • Crawford J.T.
        • Huebner R.E.
        • et al.
        The resurgence of tuberculosis: Is your laboratory ready?.
        J Clin Microbiol. 1993; 31: 767-770
        • Tokars J.I.
        • McNeil M.M.
        • Tablan O.C.
        • et al.
        Mycobacterium gordonae pseudoinfection associated with a contaminated antimicrobial solution.
        J Clin Microbiol. 1990; 28: 2765-2769
        • Vannier A.M.
        • Tarrand J.J.
        • Murray P.R.
        Mycobacterial cross contamination during radio-metric culturing.
        J Clin Microbiol. 1988; 26: 1867-1868
        • Woods G.L.
        • Pentony E.
        • Boxley M.J.
        • et al.
        Concentration of sputum by cytocentrifugation for preparation of smears for detection of acid-fast bacilli does not increase sensitivity of the fluorochrome stain.
        J Clin Microbiol. 1995; 33: 1915-1916
        • Woods G.L.
        • Witebsky F.G.
        College of American Pathologists mycobacteriology E proficiency testing survey. Summary of participant performance, 1979-1992.
        Arch Pathol Lab Med. 1995; 119: 17-22
        • Woods G.L.
        • Long T.A.
        • Witebsky F.G.
        Mycobacterial testing in clinical laboratories that participate in the College of American Pathologists Mycobacteriology Surveys: Changes in practices based on responses to 1992, 1993 and 1995 questionnaires.
        Arch Pathol Lab Med. 1996; 120: 429-435