Analysis of the performance of external quality assurance of tuberculosis sputum smear microscopy at medical institutions in Chaoyang district, Beijing
摘要: 目的对2006-2008所辖范围内的12家肺结核病防治站和12家开展抗酸杆菌（AFB）镜检的二级以上综合医院结核病实验室的痰涂片AFB镜检的质控结果进行评估。方法按照《中国结核病防治规划-痰涂片镜检质量保证手册》（EQA）的要求，对结核病实验室进行现场评价和盲法复检。结果2006-2008年痰涂片盲法复检总涂片数1671份，复检定性符合率为95.2 %、阳性定量符合率为70.2%，综合医院定性符合率95.6%、阳性定量符合率64.9%；肺结核防治站定性符合率为94.7%、阳性定量符合率为75.0%。痰涂片质量指标： 痰细胞、大小、厚薄、染色、脱落合格率分别为93.4%、66.1 %、75.4 %、91.0 %、97.1 %。结论在现场评估中，肺结核病防治站痰检人员固定，经培训后上岗，肺结核病防治站在实验室面积、仪器设备优于综合医院。综合医院痰检人员的学历和职称高于肺结核防治站。肺结核防治站的涂阳患者检出率高于综合医院。Abstract: Objectiveassess the performance of quality control of the acid-fast bacillus (AFB) microscopic examination of tuberculosis (TB) sputum smears at the tuberculosis laboratories of twelve comprehensive hospitals above the second grade and twelve tuberculosis control centers in Chaoyang District, Beijing. MethodsField evaluation and blind rechecking was performed at the tuberculosis laboratories according to the External Quality Assurance for Sputum Smear Microscopy (EQA) of Chinese Tuberculosis Prevention and Control Plan. ResultsA total of 1671 sputum smears were subject to blind re-checking from 2006 to 2008, resulting in a qualitative consistency of 95.2% and a positive quantitative consistency of 70.2%. The qualitative consistency at comprehensive hospitals was 95.6%, and positive quantitative consistency 64.9%; the qualitative consistency at tuberculosis control centers was 94.7%, and positive quantitative consistency 75.0%. Quality indexes for sputum smears, the qualification rates of sputum cell counts, size, thickness, stain and shed cells, were 93.4%, 66.1%, 75.4%, 91.0% and 97.1%, respectively. Field evaluation revealed a superiority in the laboratory areas and equipments at tuberculosis control centers, featuring stable sputum-smear examiners who had received appropriate pre-post training, over comprehensive hospitals, despite stronger educational background and professional titles of the technicians in these hospitals. The detection rate of positive patients was higher at tuberculosis control centers than that in comprehensive hospitals. ConclusionEQA blind rechecking and field evaluation are effective approaches in improving the quality of AFB sputum-smear microscopy. Further improvement is desired in the performance of AFB microscopy at medical institutions of different levels.
［1］Tuberculosis Control and Prevention Center, Chinese Center for Disease Control and Prevention; External Quality Assurance for Sputum Smear Microscopy of Chinese Tuberculosis Prevention and Control Plan［S］.Beijing: <I>Peking Union Medical College Press,</I>2005:30-37. (in Chinese)
中国疾病预防控制中心结核病预防控制中心,编. 中国结核病防治规划痰涂片镜检实验室质量保证手册［S］. 北京:中国协和医科大学出版社,2005:30-37.
［2］Wang SM. Analysis and evaluation of current quality control of sputum-smear microscopy in China ［J］. <I>Health Education on Tuberculosis,</I>2000,1(16):17-18.(in Chinese)
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