External Quality Assessment (EQA) programs are accepted around the world as invaluable tools used by laboratories to periodically assess their analytical performance and achieve added confidence in reporting their patient test results. Results are objectively compared to other laboratories using the same methodologies, instruments and reagents. When used in conjunction with daily Internal Quality controls, these external programs will assist laboratories in improving analytical quality, inter-laboratory agreement, identify potential equipment or reagent failures, and identify any training deficiencies.

The IAMM Microbiology EQAS is conducted by the Department of Clinical Microbiology, Christian Medical College, Vellore, since October 2016. The Department of Microbiology offers its services to the entire 2700 bedded main hospital, other hospitals affiliated to it, its outreach clinics, as well as to mission hospitals. The department extends a 24 hour microbiology laboratory including microscopy (simple and fluorescent) and culture of all clinical specimens for bacteria inclusive of mycobacteria and anaerobes along with antimicrobial susceptibility testing. The laboratory also provides serological tests both for infectious and autoimmune diseases. In addition, Mycology cultures and antifungal susceptibility testing are other services offered by the department.

The Department of Clinical Microbiology has been accredited by the National Accreditation Board for Testing and Calibration Laboratories (NABL) from 2014 and has subsequently been reaccredited with the Board in 2015.

This Department is well equipped and furnished with up to date equipment including phase contrast, light microscopes, fluorescence microscopes, centrifuges, Anaerobic culture system laminar flow hoods, CO2 incubators, Anaxomat automated, freezers (-20oC and -80oC), Blood culture automation systems, Bacterial identification systems like the Vitek 2, MALDI-TOF, Lyophilizers, automated ELISA stations, thermal cyclers, real time PCR instruments, nephelometers, genetic analyzer, electrophoresis apparatus,next generation sequencer (ion torrrent), sanger sequencer, gel documentation and imaging systems, software for image analysis and a with un-interrupted power supply units as required. The laboratory facilities will be used for characterization of isolates, homogeneity and stability, before dispatch to participants of the EQAS program. For performing the EQAS next use we have a dedicated area for labeling, storage and dispatch of samples. The facility also has a dedicated computer for analysis of results.

The EQAS operation involves preparation of Bacteriology smears, lyophilized culture vials and lyophilized serum vials, sealing, triple packing and distribution of packages via courier service or postal service to all the participating laboratories. The challenges are tested for homogeneity and stability conforming to the relevant international standards prior to dispatch as well as at the end of the cycle. Mailing is done during the second /third week of the month.

In the Tier I EQAS panel, each laboratory is expected to prepare a stained preparation of the smears provided either by performing a Gram stain, Ziehl-Neelsen stain or a special stain. The lyophilized culture isolates are to be revived by the suggested methods and identified. In addition, the susceptibility testing is to be done for the mentioned antimicrobials. Finally, the lyophilized sera are to be reconstituted and the requested assay performed and interpreted. All samples are to be treated as potentially infective and are to be handled with the same universal precautions as is applied to patient specimens.

The laboratories are requested to send their report on the QC packages along with the supporting evidence by the specified deadline for each EQAS cycle. The evaluations are performed on receipt of all participant reports and the individual evaluations are dispatched to each laboratory along with the overall performance summary including learning points within a month after receiving all the participant reports.

All the documents received from participants will be at the Department of Clinical Microbiology and confidentiality will be maintained. The data will be entered into the dedicated computer for evaluation, analysis and report generation. These computers will be accessed by authorized staff only.

Our participating laboratories include teaching and non-teaching hospital laboratories, government as well as private, small hospitals, private clinics and diagnostic centers. The Tier I EQAS programme offers 3 cycles in a year every year. Those who wish to enroll their names during the middle of a cycle can do so by paying the same registration fee. However, those who participate for in a minimum of 2 of the 3 QC cycles will be eligible for participation certificate at the end of the year.

Participants can contact the co-coordinator of the PT program directly by email for clarifications. We will provide all assistance towards the root cause analysis, corrective and preventive action in case of discordant results.

With regards,

V.Balaji, MD, PhD, FRCP,

Professor& Microbiology EQAS coordinator