Microsoft word - annual report 2010 _mm_ final-2.doc

MEDICAL MICROBIOLOGY
H.K. Leung, W.T. Hui, H.W. Lo, M.Y. Fung The specialty of Medical Microbiology of Hong Kong Institute of Medical Laboratory Sciences
Quality Assurance Programme (HKIMLSQAP) formerly Hong Kong Medical Technology
Association Quality Assurance Programme was first introduced in 1990. It consists of two
sections namely, bacterial identification and antimicrobial susceptibility testing. In order to
assist participants in analysing their performance, a score was given to each result. In bacterial
identification, scores of 2 or (4) were given for fully correct results, 1 or (3) for partially correct
results, 0 for negative results and -1 for wrong results. For antimicrobial susceptibility testing,
scores of 1 were given for correct results, 0 for incorrect results and NS for Not-scored results.
I.
Participants
There were 33 participants in year 2010. Table 1 shows the number and types of laboratories registered in 2010. Survey Material Distribution
Sixteen survey samples were sent in four surveys. In each distribution, each participating laboratory was provided with four lyophilised samples (three for bacterial identification and one for antimicrobial susceptibility testing) together with the Result Return Form. i. Bacteriological Identification
Simulated specimens consisted of pure culture or mixtures of relatively fastidious organisms rarely encountered bacteria were sent for identification. Participants performed well with MM 1001 (Streptococcus pyogenes), MM 1004 (Klebsiella pneumoniae), MM 1005 (carbapenemase-producing Klebsiella pneumoniae), MM 1006 Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 (Pseudomonas aeruginosa), MM 1010 (Bordetella bronchiseptica), MM 1013 (ESBL-producing Klebseilla pneumoniae) and MM 1014 (Neisseria gonorrhoeae). The all-correct percentage of 90% or above was noted. a. MM 1002 was a mixed culture of Aeromonas hydrophila and Enterococcus faecalis. Only 58% of participants were able to identify the species of both organisms. Others reported either a single pathogen or the genus of organisms. One participant reported an unexpected pathogen and was awarded a score of -1. b. MM 1007 was Corynebacterium jeikeium which might be difficult to identify. There were 69.7% of participants being able to obtain a full score in identifying this organism. One participant reported an unexpected pathogen and was given a score -1. c. MM 1009 was Salmonella cholerasuis with 81.8% of participants getting a full score, whereas 15% of the participants reported Salmonella Group C. d. MM 1011 was Aggregatibacter actinomycetemcomitans. There were 78.8% of participants correctly identified the organism. e. MM 1015 (Neisseria cinerea) was intended for educational purpose to alert participants that N. cinerea might be mis-identified as N. gonorrhoeae, which would create unnecessary anxiety, social and family disruption and potential medico-legal chaos. There were 69.7% of participants reporting the correct organism. However, five participants accounting to 15.2% reported N. gonorrhoeae. Full identification of the organisms can be accessed on-line on the homepage of Centre of Disease Control of USA websites (1,2). Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 Table 2 summarizes the details and the performance of participants in year 2010. Number of participants getting scores (%)
Intended Results
Neisseria cinerea (Educational) Not Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 Antimicrobial Susceptibility Testing

Pure cultures were sent for antimicrobial susceptibility testing. The survey results were shown in
Table 3. The methods and techniques used by participating laboratories were not shown as
diverse susceptibility testing methods were used.
Table 3 shows the performance of 33 participants in susceptibility testing.
Number of Laboratories
Intended
Test Organism
Test Agent
Incorrect
Result (%)
Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 It was noted that tobramycin, high content gentamicin and high content streptomycin were not
performed in the susceptibility testing of 36% (12), 27% (9) and 51.5% (17) participants,
respectively.
MM 1012 was a strain of NBLAR Haemophilus influenzae. Seven participants accounting to
21% did not test for beta-lactamase production. Besides, the susceptibility testings of the
organism with ampicillin, augmentin and tetracycline were suboptimal. The numbers of
participants giving correct results were 69.7%, 63.7% and 63.7%, respectively.

III Performance
Analysis
Inter-laboratory comparisons were based on results shown in Tables 2 and 3. A performance rating representing individual laboratory performance was calculated by using the formula shown below: Cumulative score of the lab Standard deviation of the cumulative score of all laboratories examining the same specimen Thus laboratories with positive performance rating were doing better than average, laboratories with a performance rating of 0 were performing the same as average and laboratories with negative rating were performing worse than average. Laboratories with a performance rating of -1.96 standard deviation below the mean were considered performing significantly worse than average. i. Bacteriological Identification
The performance of participants on the educational material was not scored. Among 363 results derived from the 11 survey specimens, 87.3% (317) of readouts being identical to the intended results were awarded a full score, 5.0% (18) being partially correct were granted a partial score, 2.8% (10) reporting negative result were offered a score of 0 and 3.6% (13) wrongly identifying organisms were given a score of -1. There was one participant with a performance rating being below -1.96. ii. Antimicrobial Susceptibility Testing
Among 33 reports derived from four survey materials, 92.3% were correct whereas 7.7% were wrong. There was one participant with a performance rating being below -1.96. Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 Laboratory Performance Report
i. Individual laboratory performance report was issued to each participant for the inter- laboratory comparison. A laboratory performance report was shown as Appendix 1 ii. Interpretative Quality Assurance Program (IQAP) was jointly organized by HKIMLSQAP and Hong Kong College of Pathologists. Clinical questions were set on two survey materials of each survey exercise for bacterial identification. It aims at monitoring the standard of practising pathologists. There were eight registrants in year 2010.

V References:

1. Division of STD Prevention, National Centre for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Centres for Disease Control and Prevention. Retrieved 1 Feb 2011. http://www.cdc.gov/std/gonorrhea/lab/Ncin.htm for Neisseria cinerea. 2. Division of STD Prevention, National Centre for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Centres for Disease Control and Prevention. Retrieved 1 Feb 2011. http://www.cdc.gov/std/gonorrhea/lab/Ngon.htm#GCGrwth for Neisseria gonorrhoeae. Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011 Appendix 1

HONG KONG INSTITUTE OF MEDICAL LABORATORY SCIENCES EVALUATION OF LABORATORY PERFORMANCE (2010)

Laboratory code: XXX

Bacterial identification:
Total number of specimens investigated by your laboratory:
Your cumulative score for the above survey specimens: Mean cumulative score of all laboratories examining same survey specimens: The standard deviation of cumulative score of all laboratories:
Your cumulative score is XX standard deviations above/below the mean

Antibiotic susceptibility testing:

Total number of antibiotic susceptibility tests performed by your laboratory:
Your cumulative score for the above tests: Your percentage of correct for the above tests: The mean percentage of correct among all laboratories:
The standard deviation of the percentage of correct results among all laboratories: 10.6

Your percentage of correct is XX standard deviations above/below the mean.
Prepared and authorized by Mr Hui Wai-Ting, Deputy Panel Head of Medical Microbiology, HKIMLSQAP Flat 1711, 17/F, Block C, Bell House, 525-543, Nathan Road, Yaumatei, Kowloon, Hong Kong Phone: (852) 2499 0015 Fax: (852) 2124 2798 E-mail: qap_info@hkimls.org URL: http://hkimls.org Date: 2nd May, 2011

Source: http://hkimlsqap.org/Information/AR/q2010/q2010cont-mm.pdf