Twenty-year review of laboratory performance on enteric parasitology external quality assessment surveys 1992–2011, Ontario Canada

Quality Management Program?CLaboratory Services (QMP?CLS) is a mandatory external quality assessment (EQA) and accreditation programme for laboratories in Ontario. This report summarizes performance of Ontario laboratories on QMP?CLS enteric parasitology EQA surveys and compares this performance over time. The results reported by participating laboratories were assessed against the expected results as determined by reference or referee laboratories. The number of laboratories licensed for parasitology decreased dramatically over the 20?years. On average, more than 80?% of participants and often more than 90?% were able to detect and identify the species and stages for the majority of parasites. Many of the challenges contained multiple parasites and about half contained low numbers, which affected performance on individual samples. The level of performance by Ontario laboratories on parasitology EQA surveys was consistently high over the 20?years. The parasites that presented the most difficulty were Enteromonas hominis and Trichomonas hominis.     

Unification of the quality assurance systems of public health laboratories conformed to ISO 17025, ISO 15189, and ISO 9000: a major organizational change

The Department of Public Health Laboratories consists of five major laboratories located across the country of Israel: four environmental laboratories performing microbiological and chemical testing of food and water products [accredited according to International Organization for Standardization (ISO) 17025 since 1999) and a fifth laboratory that is dedicated to virology testing (certified according to ISO 9000 since 2003). Historically, each laboratory operated independently and developed its own quality assurance (QA). On November 2004, an important strategic decision was made: to unify all five laboratories’ QA systems conformed to ISO 17025, ISO 15189, and ISO 9000—a transition from five laboratories operating independently in the field of QA toward establishing a multisite laboratory. This process was considered and visualized as a major organizational change and therefore raised some resistance among both QA managers and the professional laboratories’ management. Thus, it was necessary to overcome the resistance and at the same time induce thoughts of ways of reshaping and formatting the new and uniform quality manual and uniform standard operating procedures (SOPs). In September 2005, the first phase of the process was completed, and all four environmental public health laboratories successfully passed a reaccreditation audit using a uniform QA manual guide and partially uniform SOPs. We shall share our experience and discuss the major contributions of this process to overall laboratory management. Presented at the 3rd International Conference on Metrology, November 2006, Tel Aviv, Israel.     

Implementation of a quality system in a clinical laboratory – Evaluation of quality indicators

 The aim of this study was to evaluate the primary experience of implementing a quality system in a clinical laboratory. The second interrelated aim was to evaluate the quality and financial indicators needed for continuous measurement of quality, decision making in the laboratory management and everyday process control in analytical work. The quality process itself should be evaluated because the building up of a quality system requires a considerable amount of resources. The most effective and practical ways of using a quality system as a management tool should be found and the need for financial appraisal when the quality system is implemented is stressed. According to our study, when the effects of the quality system were evaluated, the managers of the laboratory had not considered the appropriate financial indicators. The quality indicators considered to be the best were internal quality control, external quality assessment and customer satisfaction surveys. The first benefits of the quality system evaluated by the personnel were other than the purely financial benefits, they include a more systematic and empowering approach to laboratory management, better working instructions, better knowledge of the methods and equipment, and fewer errors. The financial evaluation of a quality process in a public-owned clinical laboratory is complicated due to the fact that financial indicators are not as far developed and diverse as in industrial organisations. When starting to implement a quality system, it is important to pay attention to all measures that motivate the staff and help them benefit from the practical effects of the system. Received: 10 November 1999 / Accepted: 12 January 2000     

A review of proficiency testing scheme in Republic of Korea: in the field of water analysis

For regulatory purposes, it is often required to check the quality of environmental chemical analyses by routine proficiency testing (PT). In this study, the PT scheme of environmental laboratories in Republic of Korea has been reviewed. Especially, real water-based reference materials (RMs) were prepared and distributed for PT schemes. The consensus values from the PT were calculated by robust statistics with its standard uncertainties. The relative bias between the reference values and the consensus values was used as one of the indicators for the determination of the assigned values. The relationship between the performances of the laboratories, expressed by Z scores, and the concentration levels of the RMs were also revealed.     

Introduction for the special issue on the Antwerp Conferences

Quality management of laboratory medicine has become a hot topic at many conferences. Also, many national and international organizations have created working groups and committees with the task of working out standards, guidelines or recommendations for quality management of medical laboratories. We have observed that there is a great deal of interest not only from professional and scientific organizations directly involved in medical laboratory tests, but also from accreditation and certification bodies, from test laboratories in general, from in vitro diagnostic devices (IVD) manufacturers and their associations, and from other medical laboratory suppliers. However, we found that all these parties were discussing from their own point of view, without taking into account the position of other involved partners and that there was a need for creating a discussion forum for quality management in clinical laboratories. So in 1995, we started the Antwerp conferences on quality (r)evolution in clinical laboratories. The aim was to bring together all concerned partners and to establish a forum for brainstorming, independently of any pressure group. The leitmotif for the Antwerp conferences (Fig. 1) is a chain model showing the interfaces and relationships between all the partners involved in laboratory tests. During the conferences, this chain model has been examined from different angles and a summary of the concepts evolving from the discussions can be found in the conference abstracts and conference review reports in this journal. A Selection of ideas emerging from these conferences are presented below. Received: 5 October 1998 · Accepted: 20 October 1998     

Temperature-Controlled Conversion of Boc-Protected Methylene Blue: Advancing Solid-State Time-Temperature Indicators

Cold-chain management is of high importance in preserving perishable products and in retaining quality. A visible marker on packages indicating complete maintenance of the cold chain assures safe consumption of products by end-users and assists in reducing waste. Time-temperature indicators (TTIs) are integrated markers that provide information about exposure of packages to adverse temperature and have been gaining increased attention by consumers. Here we present a methylene-blue-based derivative, N,N,N′,N′-tetramethyl-N¹⁰-Boc-phenothiazine-3,7-diamine (BocPTDA), that can be used as a solid-state organic TTI dye, exhibiting an irreversible change from colorless to blue green upon heating. The conversion properties, studied using a silicagel-coated plate, confirmed that BocPTDA undergoes a color change above 20 °C. At temperatures of 4 °C and below, no visible changes are exhibited, making BocPTDA a well-suited marker for monitoring abrupt temperature deviations indicating improper cold-chain management. Thus, application of BocPTDA-based TTI systems on packages could inform consumers about the cold-chain maintenance, assuring quality and safe consumption.     

Two-stage application of the optimised uncertainty method: a practical assessment

Uncertainty estimates from routine sampling and analytical procedures can be assessed as being fit for purpose using the optimised uncertainty (OU) method. The OU method recommends an optimal level of uncertainty that should be reached in order to minimise the expected financial loss, given a misclassification of a batch as a result of the uncertainty. Sampling theory can used as a predictive tool when a change in sampling uncertainty is recommended by the OU method. The OU methodology has been applied iteratively for the first time using a case study of wholesale butter and the determination of five quality indicators (moisture, fat, solids-not-fat (SNF), peroxide value (PV) and free fatty acid (FFA)). The sampling uncertainty (s(samp)) was found to be sub-optimal for moisture and PV determination, for 3-fold composite samples. A revised sampling protocol was devised using Gy's sampling theory. It was predicted that an increase in sample mass would reduce the sampling uncertainty to the optimal level, resulting in a saving in expectation of loss of over pounds 2000 per 20 tonne batch, when compared to current methods. Application of the optimal protocol did not however, achieve the desired reduction in s(samp) due to limitations in sampling theory. The OU methodology proved to be a useful tool in identifying broad weaknesses within a routine protocol and assessing fitness for purpose. However, the successful routine application of sampling theory, as part of the optimisation process, requires substantial prior knowledge of the sampling target.     

A comparative study of the behaviour of Crystal Violet,alizarin-9-imine and quinalizarin-9-imine as indicators in anhydrous acetic acid medium

A comparative study has been made of the behaviour of alzarin-9-imine, quinalizarin-9-imine and the widely used Crystal Violet as indicators in anhydrous acetic acid medium. The protonation constants of quinalizarin-9-imine, and the properties required by a base if it is to be titratable in acetic acid medium with use of the indicators studied, the chromaticity co-ordinates, optimal concentration for titration and the quality of the colour changes have been determined. The results obtained show Crystal Violet and alizarin-9-imine to be very good indicators in acetic acid medium but alizarin-9-imine gives better end-point location. Quinalizarin-9-imine is also a good indicator but exhibits poorer colour change quality than the other two.     

Interlaboratory GC/MS response factor precision

A quality control procedure for Fused Silica Capillary Column Gas Chromatography/Mass Spectroscopy (FSCC GC/MS) was tested and shown to produce similar response factors at five Spectroscopy (FSCC GC/MS) was tested and shown to produce similar response factors at five laboratories. The average relative standard deviation (RSD) of interlaboratory response factors for fifty three compounds of environmental interest determined at each laboratory at nominal injected weights of 20, 100, and 200 ng was found to be 18.9% for four of the five laboratories which participated in this work. These data demonstrate that similar response factors can be attained in routine GC/MS measurements when adequate quality control is maintained.     

United Nations Environment Programme Capacity Building Pilot Project--training and interlaboratory study on persistent organic pollutant analysis under the Stockholm Convention

Within the framework of a United Nations Environment Programme (UNEP) Capacity Building Project for training of laboratory staff in developing countries on persistent organic pollutant (POP) analysis, an interlaboratory study was organised following an initial evaluation of the performance of laboratories (reality check) and a series of training sessions. The target compounds were polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP). Seven laboratories from five countries (Ecuador, Uruguay, Kenya, Moldova, and Fiji) participated. Most of the laboratories had no experience in determining PCBs. Although chromatograms improved considerably after the training and installation of new gas chromatographic (GC) columns at participating laboratories, the level of performance in the interlaboratory study was essentially on par with the moderate performance level achieved by European POP laboratories in the 1980s. Only some individual results were within +/-20% of the target values. The relative standard deviations (R.S.D.s) in POP concentrations determined by laboratories in a sediment sample were >200% in a number of cases. The results for a certified herring sample were better with at least some R.S.D. values below 50% and most below 100%. Clean up was as one of the main sources of error. After inspection it was ascertained that training of laboratory staff and investments in simple consumables such as glassware and GC columns would help to improve the quality of the analysis more than major investments in expensive instrumentation. Creating an effective network of POP laboratories at different continents together with a series of interlaboratory studies and workshops is suggested to improve the measurements of POPs in these countries.     

From misconception to a must: The measured merits of total quality management and accreditation in INAA

Increasingly govemmental bodies and industry require that supporting analytical laboratories have their quality assurance program implemented in a quality system by international standards such as derived from the ISO-25 guide. Neutron activation analysis (NAA) laboratories may have to deal with this trend too. In universities and research laboratories the need for it, and the implications of total quality management system are sometimes misconceived by unfamiliarity with the issue. The laboratory for INAA in Delft has been accredited for its quality system since 1993. Some of the tangible improvements since the introduction of quality management are presented. Four strategical considerations are given to consider the introduction of quality management at NAA laboratories, viz. with respect to the role of NAA for the validation of other methods, the role of NAA in the certification of reference materials, the preservation of knowledge and the acceptance of NAA as a respectable method.     

The EFQM management model for TQM applied to laboratory medicine

The EFQM (European Foundation for Quality Management) model offers a structure to describe and characterize one’s organization and allows the user to adapt the model to a great extent to the local working environment. Using five organization oriented enablers and four result oriented focused criteria, any organization, or substantial part of it, can be characterized. This accounts certainly for a medical laboratory in a hospital setting. The model tries to encourage practical usefulness and self-guidance, continuous improvement in a natural, stepwise way, and change management focused on the positive things within the organization. Application leads to consciousness of the quality of the entire operation, diagnoses, and advises for quality improvement and managerial control, i.e., through indicators. As the work of Islin and Thystrup illustrated, the EFQM model can be very elegantly and effectively applied to medical laboratories [1]. This paper is a compilation of nine lectures given in sequence to elaborate on each of the nine EFQM criteria. The following compilation explores the possibilities of using in a dedicated laboratory service this general quality management model by each of the criteria.     

A survey of non-conformances raised during accreditation inspections of medical laboratories in South Africa.

Under the auspices of the South African National Accreditation System (SANAS) the South African medical laboratory accreditation programme was established in June 1999. This study reports the non-conformances identified during the assessment of 103 medical laboratories in South Africa between September 1999 and December 2001. Laboratories were assessed by SANAS, which is the single accreditation body in the Republic of South Africa. All documentation relating to the assessment of each laboratory was reviewed in detail by the authors to identify the numbers and classification of non-conformances under each of the 25 points of the check list. A total of 862 non-conformances were raised. The top five non-conformances identified were (1) quality management system, (2) test methods, (3) records and (4) quality control and laboratory safety. The deficiencies identified in South African medical laboratories should be viewed in a positive light and promote a culture of continuous quality improvement with appropriate allocation of resources. SANAS should continue to align its requirements and procedures relating to accreditation of medical laboratories with those of their international counterparts with whom mutual recognition agreements/arrangements exist.     

The Italian way: Accreditation and continuous quality improvement in clinical laboratories

 The transition from quality assurance of the analytical phase to the quality management of total testing in clinical laboratories is still at an early stage. But it has begun. Accreditation through voluntary, educational and professional schemes, like the Clinical Pathology Accreditation scheme, is a useful tool for following defined standards of practice and having these independently confirmed on the basis of a peer review. Approved clinical laboratories can obtain a hallmark of performance and offer reassurance to users of their services. However, accreditation does not guarantee an error-free service; it is not the final step, but an important stage in the improvement process. Quality is a journey and continuous quality improvement is the paradigm for better addressing our efforts to satisfy customers' expectations for the desired health outcomes related to a high-quality laboratory service.     

A process approach to ISO/IEC 17025 in the implementation of a quality management system in testing laboratories

The introduction of quality management systems (QMS) and the accreditation of laboratories according to ISO/IEC 17025 standard are not easy tasks, mainly for those laboratories located at teaching and research institutions. During the implementation of QMS at two testing laboratories of the Federal University of Rio Grande do Sul in Brazil, new solutions to overcome some of the difficulties inherent to this type of environment have been found. The knowledge acquired through this work has led to the proposition of some general steps incorporating a process approach presented in this article, which could be of use to laboratories in their pursuit for accreditation. This proposal suggests the use of strategic planning information, links the QMS objectives to the corresponding processes and sets a few indicators to monitor both performance of and improvements to the system.     

The integration of quality management systems in testing laboratories: a practitioner’s report

Accreditation and Quality Assurance - When routine laboratories merge or are taken over by larger entities, their quality management systems usually need to be integrated. In many laboratories,...     

Implementation of a quality system in a clinical laboratory

The effects of a quality system are measured with the aid of quality indicators, which can be used for both decision-making by the management of the laboratory and for process control. The need for economic appraisal is stressed since the development of a quality system is very time- and labour-consuming. The aspects of both the customer and the personnel involved should be considered to evaluate the quality system. It is also important to define practical means to build up and maintain a quality system especially in smaller laboratories. For instance, simple tools to evaluate uncertainty of measurement and availability of inexpensive national reference materials are needed.     

How autoverification through the expert system VALAB can make your laboratory more efficient

For over 10 years now various expert systems have been on the market, but very few have reached the level of performance of Validation Assistée pour les Laboratoires d’Analyses Biologiques (VALAB). Over 25,000 rules are combined through an inference engine to reproduce human reasoning in the complex ”biological validation” process. After a review of the product concept and its development program, we will see how this ”intelligent” tool can bring quality to clinical laboratories, from a production as well as legislation point of view. With more than 140 laboratories using VALAB in Europe in daily routines, our designer and vendor experience in installation, maintenance, upgrading, reliability, efficiency, and liability is excellent. Received: 9 October 2001 Accepted: 22 July 2002 Presented at the European Conference on Quality in the Spotlight in Medical Laboratories, 7–9 October 2001, Antwerp, Belgium Correspondence to E. Rogari     

Estimating structure quality trends in the Protein Data Bank by equivalent resolution

The quality of protein structures obtained by different experimental and ab-initio calculation methods varies considerably. The methods have been evolving over time by improving both experimental designs and computational techniques, and since the primary aim of these developments is the procurement of reliable and high-quality data, better techniques resulted on average in an evolution toward higher quality structures in the Protein Data Bank (PDB). Each method leaves a specific quantitative and qualitative “trace” in the PDB entry. Certain information relevant to one method (e.g. dynamics for NMR) may be lacking for another method. Furthermore, some standard measures of quality for one method cannot be calculated for other experimental methods, e.g. crystal resolution or NMR bundle RMSD. Consequently, structures are classified in the PDB by the method used. Here we introduce a method to estimate a measure of equivalent X-ray resolution (e-resolution), expressed in units of Å, to assess the quality of any type of monomeric, single-chain protein structure, irrespective of the experimental structure determination method. We showed and compared the trends in the quality of structures in the Protein Data Bank over the last two decades for five different experimental techniques, excluding theoretical structure predictions. We observed that as new methods are introduced, they undergo a rapid method development evolution: within several years the e-resolution score becomes similar for structures obtained from the five methods and they improve from initially poor performance to acceptable quality, comparable with previously established methods, the performance of which is essentially stable.