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International Activities
WHO Workshop On The Use Of Quality Control Samples In Blood Donor Testing in Iran
Training to establish Quality Assurance in Cambodian labs
Training to establish Quality Assurance in Korean labs
Establishing Cambodian EQAS
THE NRL's International Programme
External Quality Assessment Schemes
Quality Control Programmes
Test Kit Evaluations
WHO Workshop On The Use Of Quality Control Samples In Blood Donor Testing in Iran
Sandy Walker and Scott Read recently served as short-term consultants to the World Health Organisation (WHO) to conduct a workshop on the use of quality control samples in blood donor testing. The workshop was a collaboration between the WHO, the Iranian Blood Transfusion Organisation (IBTO) and the NRL and took place in Tehran, The Islamic Republic of Iran between the 9th and 13th November 2005.
The IBTO is a non-profit governmental network of blood donation centres serving a population of over 70 million. The IBTO collects blood donations from each of Iran's 28 provinces and conducts manually-performed screening for transfusion-transmitted infections (TTI) before the blood products are distributed to more than 5000 hospitals nationwide.
Recently the IBTO under the direction of the Deputy Manager and Technical Director Dr A Talebian implemented a national quality control programme for all IBTO blood centres. The programme participants return all QC results to the IBTO headquarters in Tehran where the data are analysed.
The purpose of the workshop was to discuss a wide range of QC concepts including statistics used in quality control testing, control charts and control rules and investigating variation in QC results. The workshop also covered topics associated with quality control, including quality assurance, quality management and testing strategies.
The workshop was attended by a quality officer from each of the 28 provincial blood donation centres, the Quality Control Manager of IBTO, Dr S. Amini, and the OH&S Manager of IBTO Mr Mostafa Moghaddam. Dr Amini and Mr Moghaddam also provided fluent sequential translation of the lectures from English to Farsi.
At the end of the workshop participants were asked to complete a questionnaire designed to assess the overall impact of the workshop in terms of relevance, educational value and interest. In all categories surveyed, the majority of participants rated each category as either "excellent" or "good".
Following the completion of the workshop the IBTO invited Sandy and Scott to the southern city of Shiraz (in the Fars Province) to visit the provincial blood donation centre managed by Dr Torabe Jahromi.
The IBTO and the NRL will continue to collaborate in future projects. Current discussions between the two groups include the participation of thirty of the IBTO screening laboratories in the NRL's External Quality Assessment Scheme (EQAS) and NRL's provision of external auditing services.
On behalf of the NRL, Sandy and Scott would like to thank the group at IBTO for the generous and warm hospitality they received during their time in Iran.
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IBTO Building, Tehran | Participants of the Workshop | From Left: Dr. S Amini, Mr. Mostafa Moghaddam, Dr. A Talebian, Scott Read & Sandy Walker |
Training to establish Quality Assurance in Cambodian labs
Mao Sarim from the National Public Health Laboratory (NPHL), Cambodia, attended the NRL between 8 and 19 August 2005 to receive training in Quality Assurance. The NPHL is in the process of implementing an EQAS for 18 provincial laboratories in Cambodia that test for anti-HIV, anti-HCV, HBsAg and Syphilis. During his time at the NRL Mao Sarim will receive training in coordinating EQAS and implementation of Quality Management Systems.
Training to establish Quality Assurance in Korean labs
Dr. Haeng-Seop Shin from the Center for AIDS Research, National Institute of Health, Korea Centre for Disease Control and Prevention, Korea, attended the NRL between 8 and 12 August 2005 to receive training in Quality Assurance. Dr Shin's laboratory is involved in the provision of an anti-HIV External Quality Assessment Scheme (EQAS) to approximately 800 laboratories in Korea. During his time at the NRL Dr Shin received training in coordinating EQAS, Quality Control and implementation of Quality Management Systems.
Establishing Cambodian EQAS
In 2003 the NRL become a partner in the Centers for Disease Control and Prevention, Global AIDS Program (CDC GAP) for the Southeast Asian region. Elizabeth Dax, as part of a CDC team, has conducted country-wide laboratory surveys in Cambodia (2003) and Vietnam (2004). It was recommended, as an outcome of the survey and as part of an ongoing plan for Cambodia, that the National Public Health Laboratory in Cambodia administer an external quality assessment scheme (EQAS) for HIV testing to provincial laboratories by 2006. As a continuing activity of the CDC GAP's program to strengthen the laboratories in Cambodia, a plan was formulated to assist in establishing a national EQAS for Cambodia. A workshop was carried out in Phnom Penh over the last two weeks as the first step in accomplishing this plan. The facilitators were Elizabeth Dax and Sandy Walker from the NRL, Wilai Chalermchan from the Quality Assurance of HIV Testing Section, National Institute of Health in Thailand and Somboon Nookai from the HIV Technical Support, Laboratory Services Section, CDC GAP in Thailand.
The Thai NIH Laboratory sent EQAS challenges for HIV, HCV and HBsAg testing through the National Public Health Laboratory in Cambodia in late March. The workshop was then carried out to review the results with the national laboratory staff, to review the results with the provincial laboratory staff at the same time assuring that they understood their roles and responsibilities as participants in an EQAS and introduce them to the process of EQAS and its administration. The participants were enthusiastic and our two weeks in Phnom Penh generated some excellent ideas on the proposed EQAS. The facilitators agreed that the development of the EQAS will be an interesting and exciting project to follow. The second panel distribution for Cambodian laboratories is planned for June.
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| The Facilitators and Workshop translators meeting with the Director and Deputy of the NIPH. Left to Right: Buth Sokhal, Dr Soth Vuthy, Dr Sam An Ung, Elizabeth Dax, Sandy Walker, Wilai Chalermchan, Somboon Nookia and Mom Chandara. | Elizabeth Dax presenting a Certificate of Workshop Participation at the conclusion of the Cambodian Workshop. |
THE NRL's International Programme
THE NRL's International Programme extends the use of the methods employed in its Australian Quality Assurance Programmes. Since the late 1980s the NRL has been a WHO Collaborating Centre and as such has had a focus on assisting laboratories in countries where resources are limited. NRL has partnered or worked with other organizations to extend its own resources. Such organizations included the US Centers for Disease Control and Prevention, Global AIDS Program, the World Bank, regional offices of the WHO, country programmes, and the International Consortium on Blood Safety.
External Quality Assessment Schemes
Since 1989 NRL has been distributing External Quality Assessment Schemes (EQAS) to national and more major laboratories including major blood service laboratories of the South-east Asian and Western Pacific Regions and beyond. Each EQAS panel or exercise usual consists of 10 samples and the panels are distributed twice yearly. When laboratories receive their panels they are tested, and the results are relayed to the NRL by email or fax. After the deadline for the return of the results all participating laboratories receive notification of the correct results. All results are then compiled into a report which laboratories may use to compare their own performances with those of others and be given reasons why aberrant results may occur. Also laboratories are given ways in which they can interact with the NRL to discuss ways in which performances and quality may be improved.
Quality Control Programmes
Quality controls (QCs) should be used in every run of an assay or frequently enough to gauge its ongoing performance. This includes assessing the consistency of performance of rapid and or simple assays. Use of quality controls allows laboratory personnel to monitor the precision of an assay or laboratory test. However, the accuracy of the test's results can only be ascertained if results between laboratories are compared. The NRL offers any laboratory access to its internet-based application, EDCNet. As a participant in a QC programme using QCs supplied by the NRL, commercially obtained QCs or in-house manufactured QCs the on-going performances may be monitored. If others are using the same system with the same QC the accuracy may be determined. More recently international laboratory guidelines are requiring laboratories to be able to assess a measurement of uncertainty for all quantitative assays. The use of QC samples and their performance monitoring over time is a most effective way to follow the uncertainty of a testing system. The NRL offers QCs and EDCNet access to NRL-WHO participants but others can use EDCNet for a moderate fee. Internationally there are more than 100 laboratories in 20 countries using EDCNet.
Test Kit Evaluations
The NRL conducts pre-market evaluations of test kits under contract to the Australian Regulator (the Therapeutics Goods Administration). Advice on conducting or performing evaluations or validations may be obtained from the NRL. In some cases where the NRL has samples available, panels may be prepared as a service. NRL publishes the results of its own evaluations in its monthly Newsletter, News and Reviews on Line and on the Assay Evaluations page of the Publications and Presentations section of our webpage.
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