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External quality assessment (EQA) combined with on-site technical evaluation for capacity building in clinical microbiology laboratories in Pakistan

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Abstract

Objectives

Implementation of standard laboratory practices towards accurate antimicrobial susceptibility testing (AST) is challenging in resource-constrained settings. Efforts to improve AST are required to address knowledge and practice gaps in such settings. In this study, we aimed to address these gaps through external quality assurance surveys and mentoring of laboratories in Pakistan.

Methods

This prospective study (May 2017–September 2019) included 10 consenting laboratories. External quality assessment (EQA) was conducted quarterly and performance scored. Each EQA cycle was followed by an on-site technical visit during which AST methodology, quality procedures and laboratory safety were evaluated using a questionnaire developed for this study. Cumulative scores of performance in the EQA and in the technical evaluation were designated “Composite Laboratory Performance Score; CLPS”. During on-site visits, feedback provided was to each participating laboratory towards addressing gaps identified.

Results

Over the course of the study, our data show significant improvement in CLPS amongst the laboratories included. While improvement in the CLPS scores varied between laboratories, a linear regression model showed improvement within the cohort from 21.37 (May 2017) to 91.5 (September 2019); a significant overall increase of 70.13 points (p = 0.001).

Conclusion

Interventions to improve AMR surveillance include quality assured reporting of antimicrobial resistance. Our data show that in resource-limited settings EQA surveys and on-site evaluations followed by guidance contribute towards such improvement. We propose that this model would be a useful tool for laboratory strengthening in such settings.

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Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

We would like to thank Health Security Partners (HSP)-USA for funding this project and Ms. Jessica McLean for her generous support and assistance throughout the course of this study. We would also like to thank all the participating laboratories for taking part in this activity. Finally, we would like to extend our gratitude to the staff of Department of Pathology and Laboratory Medicine for help during the project and especially for their help in preparing the EQA panels.

Funding

His study was supported by the Health Security Partners (HSP)-USA, as part of their collaboration with the Department of Pathology and Laboratory Medicine, Aga Khan University, for laboratory capacity building and strengthening for antimicrobial resistance surveillance. We declare that there was no competing interest by the funding agency in determining or influencing the study at any point.

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Authors and Affiliations

  1. Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan

    Noureen Saeed, Muhammad Zeeshan, Dania Khalid Saeed, Joveria Farooqi, Sadia Shakoor, Imran Ahmed, Kausar Jabeen & Rumina Hasan

  2. Health Security Partners, Washington, DC, 20009, USA

    Jason Rao

  3. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

    Rumina Hasan

Authors
  1. Noureen Saeed
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  2. Muhammad Zeeshan
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  3. Dania Khalid Saeed
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  4. Joveria Farooqi
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  5. Sadia Shakoor
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  6. Imran Ahmed
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  7. Kausar Jabeen
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  8. Jason Rao
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  9. Rumina Hasan
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Contributions

RH, JF, SS and JR were involved in study conception and design. RH, NS, DKS, KJ, JF, MZ and IA contributed to acquisition of data. JFR and NS were involved in analysis and interpretation of data. RH, MZ, NS, JF and KJ contributed to drafting of manuscript. RH, SS and KJ were involved in critical revision.

Corresponding author

Correspondence to Rumina Hasan.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Ethical standards

This study was approved by the Ethical Review Committee Aga Khan University, Karachi, Pakistan (ERC# 3487-Pat-ERC-15).

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Saeed, N., Zeeshan, M., Saeed, D.K. et al. External quality assessment (EQA) combined with on-site technical evaluation for capacity building in clinical microbiology laboratories in Pakistan. Accred Qual Assur 27, 103–110 (2022). https://doi.org/10.1007/s00769-022-01495-x

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  • DOI: https://doi.org/10.1007/s00769-022-01495-x

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