| |
Module |
Learning Objectives |
Content Outline |
| 1 |
Overview: Tuberculosis, the Global Emergency |
• Explain the TB epidemic and global TB burden
• Describe the forms of TB and how TB is transmitted
• Define and compare various methods of TB diagnosis noting where each is most effective
• Explain the term NTP
• Describe the DOTS component of the STOP TB strategy
• Explain the importance of AFB microscopy in the DOTS Program
• Describe levels of TB laboratory services
|
• What is TB?
• Transmission and Forms of TB
• Risk of Disease
• TB Diagnosis
• The role of the National TB Program
• Building and Enhancing DOTS within the framework of the STOP TB strategy
• The importance of AFB-microscopy in DOTS programs
• Organization of laboratory services
|
|
| 2 |
Safety Precautions for Tuberculosis Microscopy |
• Explain airborne transmission of TB
• Describe the risks when collecting sputum
• Describe personal health and safety practices
• Describe why there should be three areas in the TB laboratory
• Describe methods for the disposal of contaminated material
• Describe chemical safety precautions in the laboratory
|
• Transmission of TB bacilli
• Proper collection of sputum
• Laboratory Arrangement
• Safety practices in the TB microscopy laboratory
• Safe disposal of infectious waste
• Chemical Safety
|
|
| 3 |
Collection and Transport of Tuberculosis Specimens |
• Describe specifications of suitable containers for sputum collection
• Explain the collection strategy: spot-morning-spot
• Describe and demonstrate safe and correct collection of sputum
• Describe options for specimen collection, handling, and transport
• List features of a good sputum specimen
• Describe requirements for a properly labeled specimen
|
• Suitable specimen containers
• The number and timing of specimen collection
• How to collect a specimen
• Specimen handling and referral
• Assessing specimen quality
|
|
| 4 |
Managing Supplies for Sputum Smear Microscopy |
• List supplies required to perform smear microscopy
• Explain ordering of supplies
• Maintain proper records
• Explain use of stock book
• Calculate supplies required
• Inspect and verify supplies received
• Explain storage of supplies.
|
• Supply list for smear microscopy
• Supply storage
• Stock management
• Recordkeeping: Stock book use and importance
• Calculating supplies required
• Placing, receiving, and storing supply orders
|
|
| 5 |
Preparation of Ziehl-Neelson Reagents |
• Describe the importance of using quality chemicals for reagent preparation.
• Prepare reagents required for the Ziehl-Neelsen method
• Describe the safety requirements for reagent preparation
• Use positive and negative control slides for the quality control of Ziehl-Neelsen reagents
• Explain the use and frequency of routine quality control procedures.
|
• Equipment required for stain preparation
• Reagent required for stain preparation
• Methods for staining reagents preparation
• Storage of staining reagents
• Quality Control (QC) of freshly prepared stains
|
|
| 6 |
Smear Preparation and Staining |
• Safely prepare sputum smears
• Prepare good quality sputum smears
• Identify problems with smear preparation
• Perform the Ziehl-Neelsen (ZN) method on sputum smears
• Troubleshoot problems with the ZN method
|
• Labeling of slides
• Selecting the best portion of the specimen for smear preparation.
• Techniques for preparing smears
• Principles of the Ziehl-Neelsen method
• The Ziehl-Neelsen staining procedure
|
|
| 7 |
Microscopy |
• Describe the method for observing 100 high power fields
• Correctly use microscope objectives
• Recognize the appearance of AFB in a stained smear
• Appropriately quantify results in the Laboratory Register.
• Describe the procedure for storing slides for External Quality Assessment (EQA).
|
• Required materials
• Reading the smear
• Microscope components and operation
• Appearance of AFB
• WHO/ IUATLD grading scale
• Storing smears
• Cleaning the objectives
|
|
| 8 |
Recording and Reporting of Smears |
• Describe essential elements of recording and reporting
• Describe the quantification scheme for reporting results
• Report microscopy results on the Laboratory Request Form
• Record microscopy results correctly in the Laboratory Register
|
• Essential elements of Record Keeping
• Laboratory request and report forms
• Recording and reporting results: Negative and Positive
• Entry of data into the Laboratory Register
|
|
| 9 |
Microscope Maintenance |
• Store the microscope properly
• Clean the microscope including the eye pieces and objective lenses
• Replace the microscope bulb
• Troubleshoot the common problems associated with use of microscope
|
• Microscope storage conditions
• Equipment required for Microscope Maintenance
• Cleaning solutions and solvent required to clean optics, stage , and body
• Materials required for cleaning
|
|
| 10 |
Assuring Quality of Sputum Microscopy |
• Describe the elements of Quality Assurance
• Explain why internal Quality Control is important to assessing laboratory performance
• Describe the three components of External Quality Assurance (EQA)
• Prepare for a supervisory visit
• Describe the process of sampling slides for blinded smear rechecking
|
• What is Quality Assurance?
• Quality Control in the TB laboratory
• EQA and why is it important
• EQA Methods
- Panel Testing
- On-Site Evaluation
- Blinded Rechecking
|
|
Learning Methods / Activities:
The AFB Microscopy workshop includes the following types of activities to aid in accomplishing workshop goals and objectives:
- Presentations will allow participants gain knowledge through interactive exchange of information.
- Group discussions will allow participants to share experiences and ideas.
- Role plays will allow participants to learn through simulated situations.
- Video presentations will introduce participants to the procedural steps for collecting sputum specimens, performing tests, and interpretation of results. The video "Acid-Fast Direct Smear Microscopy" is provided as an additional resource.
- Demonstrations will allow participants to observe procedures prior to individual performance.
- "Hands-on" practice exercises will allow participants to experience the range of practical activities for acid-fast direct smear microscopy.
For further details on these activities, and detailed suggestions for facilitating each of the modules of instruction, refer to Section 4: Presentation Slides and Trainer Notes for each module.
|
List of Practical Exercises
Module 1: TB transmission (Optional) - Demonstration
Module 3: Collection of sputum specimen- Role-play
Module 4: Exercise 1- Calculation of quarterly supply requirements for a microscopy center that receives prepared staining reagents- Classroom exercise
Exercise 2- Calculation of quarterly supply requirements for a microscopy center that prepares its own staining reagents- Classroom exercise
Module 5: Laboratory Practical session # 1 - Reagent preparation
Laboratory Practical session # 2 - Quality Control of staining reagents
Module 6: Laboratory Practical session # 3 - Preparation of smears
Laboratory Practical session # 4 - Staining of sputum smears (from Laboratory Practical Session # 3 and panel smears)
Module 7: Laboratory Practical session # 5 - Viewing of prepared and stained smears from Laboratory Practical Session # 4
Module 8: Laboratory Practical session # 6 - Reading and reporting of stained panel smears from Laboratory Practical Session # 4
Module 9: Replacing the Microscope Bulb - Demonstration
Final examination: Reading of Pre-stained Panel smears
|
Certificate of Participation
Participants are awarded a certificate of participation upon successful completion of the Acid Fast Direct Smear Microscopy training workshop by
- Daily attendance and actively participating in the laboratory practical sessions
- Complete written post - workshop examination
- Successfully reporting the AFB smear results by completing EQA panel test examination.
|