ISSUING THE GUIDELINES ON DEVELOPMENT OF STANDARD PRACTICE PROCEDURE IN MANAGEMENT OF LABORATORY QUALITY

Article 1. Issuing with this Decision the “Guideline on development of standard practice procedure in management of laboratory quality” at medical facilities.

Article 2. The Guidelines on development of standard practice procedure in management of laboratory quality are applied at the medical facilities to gradually standardize the laboratory quality.

Article 3. This Decision takes effect from its signing date for issue.

Article 4. Chief of Ministry Office, Director of Agency of Medical Services Administration, Director of hospitals directly under the Ministry of Health, Director of Department of Health of provincies and centrally-run cities, the medical units of Ministries, sectors, Director of laboratory quality control centers and Head of relevant units are liable to execute this Decision./.

 

 

DEVELOPMENT OF STANDARD PRACTICE PROCEDURE IN MANAGEMENT OF LABORATORY QUALITY
(Issued with Decision No. 5530/QD-BYT dated 25/12/2015 of the Minister of Health)

In recent years, the management of laboratory quality has received the special attention and steering from the Ministry of Health to improve the capacity of laboratory system, ensure the laboratory result is accurate, timely, avoid waste and save money for patients. In 2013, the Ministry of Health issued the Circular No. 01/2013/TT-BYT on “Guidelines on development of standard practice procedure in management of laboratory quality are applied at the medical facilities” specifying that all units must develop the standard practice procedure. This is one of the important tasks in management of laboratory quality to ensure the work is done consistently and the laboratory result is standardized and accurate.

For the time being, a lot of units have implemented the above Circular. The laboratory quality is constantly improved and better controlled. However, there are in fact laboratories at medical facilities with standard laboratory procedures but incomplete, inconsistent and without high efficiency; there are also laborotories having inadequate or no standard laboratory procedures in prescribed quality management. The above problems are due to many causes and one of them is that there are officers, managers and persons performing laboratory work not understand the role and importance of compliance with the standard laboratory procedures in management of laboratory quality.

Therefore, the requirement laid down is to standardize and provide complete, detailed and systematic guidelines in developing the standard laboratory procedures in management of laboratory quality, providing assistance in assessment and examination of laboratory results and monitoring in a objective manner to ensure the laboratory result. The issue of guidelines on compiling the standard practice procedure in management of laboratory quality is very necessary.

The content of the Guidelines includes 03 chapters and annex 1 and 2, specify name and sample examples on standard practice procedure in management of laboratory quality.

This is the first time there is a complete guideline on developing the standard practice procedure in the management of laboratory quality. Therefore, the shortcomings are inevitable. The Ministry of Health (Agency of Medical Services Administration) is looking forward to receiving the comments from the units, individuals and experts to so that this Guideline material is increasingly improved with better quality in order to contribute to the highest benefits for patients.

 

 

Assoc. Prof. Dr.. Nguyen Thi Xuyen

Assoc. Prof. Dr. Luong Ngoc Khue

MMed.. Nguyen Trong Khoa

MMed. Dao Nguyen Minh

Dr.. Bui Thu Hien

MMed. Do Thi Thu Thuy

Dr. Duong Ngoc Cuong

MMed. Le Sinh Quan

Assoc. Prof. Dr. Dang Thi Ngoc Dung

MMed. Truong Quan Thuy

Dr. Nguyen Hong Hanh

Dr.Vu Van Truong

 

 

 

Chapter I

GENERAL PROVISIONS

I. Purpose

II. Subjects of application

III. Explanation of terms

IV. Implementation principles

Chapter II

STEPS TO DEVELOP THE STANDARD PRACTICE PROCEDURE

1. Preparation for development plan

2. Review and modification

3. Approval and issue

4. Training and use

5. Modification, addition and storage

Chapter III

GUIDELINES ON DRAFTING OF STANDARD PRACTICE PROCEDURE

I. Requirements for presentation

II. Requirements for minimum contents of standard practice procedure

REFERENCES

ANNEXES

 

Guiding the drafting of standard practice procedure in management of laboratory quality (abbreviated as QTC), including the standard practice procedure on management and techniques in management of laboratory quality.

1. Leadership of medical facilities;

2. Staff of laboratory;

3. Other relevant individuals and units in management of laboratory quality.

The standard practice procedure (or standard operating procedure) in management of laboratory quality is a document guiding in detail and showing the way to conduct a specific work in management and technical skills to ensure the activities shall be done consistently with regulations.

1. Develop a standard practice procedure for all activities of management and technical skills.

2. The contents in this standard practice procedure must be written clearly, concisely, completely, understandable and comply with the guiding documents.

3. The standard practice procedure must be issued by the leadership of units or person having the authority to approve and issue each separate procedure.

4. The standard practice procedure must be annually reviewed and must be updated and re-approved in case of modification and in case of no modification, no approval is needed but the review must be documented.

5. The contents and presentation of standard practice procedure of each establishment can be adjusted accordingly but must ensure the requirements of such Guidelines.

- Making list of Standard Practice Procedure is based on the following main grounds:

+ The approved technical list of the units;

+ The work related to the quality management;

+ Classification of work to be done with priority at the laboratory.

- Assignment of person (or group of persons) drafting and person (or group of persons) making review.

- Performance of drafting as guided in Chapter III.

- The assigned persons are responsible for review and modification.

- The process of review and modification includes the following steps:

+ Send the draft to the reviewer;

+ Agree upon modified comments;

+ Modify the draft (if needed);

+ Send back the modified draft to the drafting group and request feedback at a definite time;

+ Summarize all comments to complete the Standard Practice Procedure (hold meeting to agree on the contents if necessary).

+ Control the format of Procedure and its contents with checklist before submission to the leadership for approval;

+ The writer and reviewer sign and specify the respective date and month;

Note: This modification process can be done many times until there is an agreement on content and form of the Procedure (the final draft).

- The leadership or the competent person of the unit shall approve the Standard Practice Procedure.

- Announcing the approved Standard Practice Procedure.

- Distributing the copy of Standard Practice Procedure to all relevant staff and departments.

- The training and use of Standard Practice Procedure for all relevant staff is done from 7 – 10 days after the issue of Standard Practice Procedure and documentation of dossier of persons involved in the training.

- Ensure the strict compliance with the issued Standard Practice Procedure and prepare dossier to record the remedial actions.

- It is necessary to modify or add the contents when there are modifications on regulations or policies of the units or when the Standard Practice Procedure is no longer consistent.

- Keep the original of Standard Practice Procedure as stipulated.

- Recover all issued old versions of Standard Practice Procedure upon issue of alternative procedure and keep it as stipulated.

1. General presentation:

All Standard Practice Procedures are presented in the form as follows:

- Paper size: The Standard Practice Procedures are presented on paper with size A4 (210 mm x 297 mm).

- Type of presentation: with the portrait form of paper size A4. In case the Standard Practice Procedure has tables, the text can be presented with the landscape form of paper.

- Font: Times New Roman

- Encoding: Unicode

- Font size: 13-14

- Top margin: 2cm from the top edge

- Bottom margin: 2cm from the bottom edge

- Right margin: 2cm from the right edge

- Left margin: 3cm from the left edge

- Space between lines: 1.5 lines

2. Specific presentation:

2.1. The first page of Standard Practice Procedure includes the following

2.1.1. Name of body and department, logo (if any);

2.1.2. Name of standard procedure

2.1.3. Code of document: Each Standard Practice Procedure needs to be coded separately and uniquely, may be symbolized with the abbreviation of each department or by classification of Standard Practice Procedure (management procedure and technical procedure), for example:

The culture procedure of microbiology department is symbolized as QTKT-VSNC - 01, in which:

+ QT as abbreviation of procedure;

+ KT as abbreviation of technique;

+ VS as abbreviation of Microbiology Department;

+ NC as abbreviation of culture;

+ 01 is the first Standard Practice Procedure drafted by the microbiology department and numbered 01.

2.1.4. Version (order of issue): It is required to number in ascending order each time of issue of Standard Practice Procedure with Arabic number, for example:

When drafting the new procedure “Material control” in 2014, the first version is symbolized as 1.0. In 2015, there is the first modification, the new version is 1.1 or 2.0.

2.1.5. Effective date: Specify the effective date in the Standard Practice Procedure after it has been issued.

2.1.6. Full name, signature and position of the writers, verifier and approver.

2.1.7. Monitoring the modification of standard practice procedure: Specify information on modification/addition of content of standard practice procedure as guided in the following table:

2.2. From the second page onward of the standard practice procedure, the presentation is done as follows:

The header and the footer will appear in each page of standard practice procedure, these parts include: name of standard practice procedure, code of document, version and ordinal number/total pages, for example:

The header is presented as follows:

The footer is presented as follows:

3. Way to number the levels of heading:

3.1. The main headings has bold Arabic number, ex: 1., 2., ...

3.2. The subordinate headings under the main heading are numbered in ascending order of the main heading as follows:

- Level 1: bold and italic, ex: 1.1., 1.2., ...

- Level 2: regular, ex: 1.1.1., 1.1.2., ...

- The following levels: regular, ex: 1.1.1.1., 1.1.1.2. ...

- The main ideas under the main or subordinate headings have the symbol (-).

- The minor ideas following the main ideas have symbol (+) and followed by (•).

For example

1) Purpose;

2) Scope of application;

3) Responsibility;

4) Definition, terms and abbreviation;

5) Principle;

6) Equipment and material;

7) Quality control;

8) Safety;

9) Implementation content;

10)  Interpretation of result and report;

11) Note (warning);

12) Dossier storage;

13) Relevant documents;

14) References.

1) Purpose;

2) Scope of application;

3) Responsibility;

4) Definition, terms and abbreviation;

5) Implementation content;

6) Dossier storage;

7) Relevant documents;

8) References

Note: The content of one management standard practice procedure or technical standard practice procedure shall include the above items and specify not applicable for items which do not exist to ensure all standard practice procedures have uniform items.

 

1. Circular No. 01/2013/TT-BYT dated 11/01/2013 of the Minister of Health guiding the implementation of management of laboratory quality at medical facilities.

2. Decision No. 3701/QD-BYT issuing the “National action program on improvement of medical laboratory management capacity from now to 2020”.

3. National standard, 2014, medical laboratory – Requirements for quality and capacity (TCVN7782:2014- ISO 15189:2012), Hanoi.

4. Circular No. 01/2011/TT-BNV dated 19/01/2011 of the Ministry of Interior guiding the formality and techniques for presentation of administration documents.

1. World Health Organization, 1997. A WHO guide to Good Manufacturing Practice (GMP) requirement, Part 1: Standard Operation Procedure and master formulae, p12-111

2. Clinical and Laboratory Standards Institute, 2002. Clinical laboratory and technical procedure manuals; Approved guideline 4th Edition. GP2-A4 Appendix A. Suggested Contents of Laboratory Procedures. NCCLS: Wayne, Pennsylvania, p.19.

3. United States Environmental Protection Agency, 2007. Guidance for Preparing Standard Operation, 2007, p 6-60.

4. World Health Organization, 2011. Laboratory Quality Management System - Handbook, Document and Record, p. 181.

5. World Health Organization, 2011. Laboratory Quality Standards and their Implementation-South-East Asia Region, Annex 5, p.39-45.

6. ISO 15189:2012, Medical laboratories - Particular requirements for quality and competence, 2012.

7. Clinical and Laboratory Standards Institute, 2013. Quality Management System - Development and Management of Laboratory Documents; Approved guideline 6th Edition, p.9-10.

 

LIST OF MANAGEMENT STANDARD PROCEDURE OF LABORATORY QUALITY

 

EXAMPLE OF SAMPLE OF STANDARD PRACTICE PROCEDURE FOR DOCUMENT CONTROL

 

- Guide the regulations on management of internal documents and external documents of the quality system to ensure the staff in the department have the current regulations and procedures for implementation.

- To be applied in divisions of XX laboratory department – XXX General Hospital.

- All divisions of XX laboratory department must control documents as stipulated.

- The quality controller shall manage, guide and monitor the procedure implementation.

- The Head of department shall manage all documents in general.

- Documents: the guiding documents (paper or electronic form) including the regulations, policies, procedures, forms, reports. The documents can be in the form of text or electronic form.

- Internal document: Quality handbook, management procedure, technical procedure, work, equipment and safe instructions and other applicable forms. Dossiers are out of this scope.

- External documents: are the ones written and issued by external organizations including legal normative documents, international standards, national standards, accreditation and certification documents, manual of manufacturer and guiding official letters.

- Obsolete documents: are the invalid ones or have new versions for replacement or invalidation by order.

- BM                 Form

- PDF

- QLCL              Quản lý chất lượng/ Quality management

- QLKT              Quản lý kỹ thuật/ Technical management

- QTQL              Quy trình quản lý/ Management procedure

- There are signatures in blue ink of the writer, reviewer and approver.

- There are red seals of “ORIGINAL” and “CONTROL DOCUMENT” on the first page with seals on remaining pages of document. The document is effective from its issuance date

- Are copied from the original so all signatures and seal “ORIGINAL” are in black ink.

- There must be a seal “CONTROLLED COPY” in red ink at the top center of each page. At the bottom of page, write the ordinal number of copy in blue ink.

- The documents with prescribed above features are the legal documents of the quality system.

5.3.1. Issue of document

- After the document is signed for approval, the quality controller shall:

+ Specify the validity date on each page of document;

+ Affix the seal “ORIGINAL” and “CONTROL DOCUMENT” on each page in the upper right corner;

+ Make copies and distribute documents in accordance with item 5.5.2;

+ Update the name of document in the “List of controlled internal documents” under the form with code No. XX-QTQL-01-BM01 and keep this list. This list only shows the current controlled document versions.

+ Keep the original in locked cabinet at room as stipulated under item 5.5.6;

+ Make training plan for staff on newly-issued documents.

5.3.2. Document copy and distribution

- Only the quality controller has the right to:

+ Make copy and provide documents of quality system as requested by other divisions in department;

+ Print the correct number of copies under the distribution list specified in the document and there must be the approval from the head of department in case of additional printing;

+ Affix the seal “CONTROLLED COPY” and write the ordinal number of copy on each page of copy;

+ Distribute the copies of document to the units/individuals named in the distribution list. When delivering documents, the person distributing documents must do an update in the “Document distribution/recovery monitoring book” under the form No. XX-QTQL-03-BM03.

+ The control documents can be distributed in the electronic form (PDF form) with sunken words “CONTROL COPY” from the email address of the quality controller or USB.

5.3.3. Periodical review

- At the beginning of each quarter, the quality controller shall make a list of documents to be reviewed in that quarter of the department and send a written notice so that the divisions in department can review the content of document in their divisions.

- All documents shall be reviewed 1year/time.

- The reviewer completes the “Periodical document review sheet” under the form No. XX-QTQL-01-BM05.

- In case of modification, follow the document modification order specified in item 5.2.3.

5.3.4. Document modification and re-issue

- All staff can suggest modification of documents. The requester shall complete the “Document drafting/modification request sheet” under the form No. XX-QTQL-01-BM04.

- The modified contents shall be reviewed and approved by the competent person as follows:

- The modifier shall update the modified information in the table “Monitoring of document modification” on the first page of document. The modified content in the document must be marked in the right margin.

- The modifier shall save the electronic files of modified documents in the different name (in accordance with naming regulation under item 5.3.1). Update the information in the excel file “Monitoring of document modification”.

- When issuing new documents, the quality controller shall recover the old documents as stipulated in item 5.2.5.

- The quality controller shall re-distribute the modified documents to the relevant units/individuals and do an update in the “List of controlled internal documents” under the form No. XX-QTQL-01-BM01 and the “Document distribution/recovery monitoring book” under the form No. XX-QTQL-4.3-BM03.

5.3.5. Use of documents

- The quality controller shall keep the original documents. The staff of department shall use the copy or electronic files only.

- As for the blank forms used for information completion, the quality controller shall print 01 copy for each type of form and affix the seal “CONTROL DOCUMENT” on the back of the blank forms and put them in the file folder for the relevant persons to use them. The users can make copies from such control form.

- The users must check/compare to ensure the use of most updated version of form.

- After being completed with information, the blank forms shall become dossier and be managed under the procedure “Dossier management” with code XX-QTQL-10.

5.3.6. Document recovery and destruction

- The invalid controlled documents, old versions of modified or unused documents must be recovered; do an updated in the “Document distribution/recovery monitoring book” under the form No. XX-QTQL-01-BM03.

Note: The Department shall not recover the uncontrolled copies.

- Affix the red seal “INVALIDITY” on the recovered document and write the date of invalidity.

Upon destruction of documents (text or electronic file), ensure they cannot be restored and only destroying them when there are new versions for replacement and the archiving time is in accordance with regulation.

- Update the information on document destruction in the “Document destruction sheet” under the form No. XX-QTQL-03-BM06.

- Keep one original in at least 3 years after destruction.

5.4.1. Principles to name the file of documents

- The documents in the electronic form are named using the following rules: Document code – time of issue

- Ex:

+ The electronic file of procedure “Document control”, time of issue: 1.2. shall be saved with the following name: XX-QTQL-01_1.2.

+ The electronic file of form “Document destruction sheet”, time of issue: 2.2 shall be saved with the following name: XX-QTQL-01-BM06_2.2.

5.4.2. Document update and storage

- All electronic documents must be saved in the computer with appropriate forms of security (ex: password) to avoid any accidental / intentional change of content of document.

- These documents must be backed up into CD/external hard drive at least 3 months/time. Every time of backup, name the backup folder by year, month and date of backup. The CD/external hard drive must be placed in the locked cabinet under the quality controller’s management.

5.4.3. Document management and distribution

- All documents in electronic form upon distributed must be converted into “PDF” form.

- As for the forms which can be distributed in Microsoft Word format. However, when using, the users have to check/compare to ensure the use of most updated version of form.

5.5.1. Document identification

- When the external documents are transferred to the units, the quality controller shall do an update in the “List of external controlled documents” under the form No. XX-QTQL-01-BM02, affix the red seal “CONTROL DOCUMENT” on the first page of documents and deliver them to the relevant officer to handle, manage or submit them to the unit leadership for processing.

- With the external documents related to the system of quality management, the competent person must do an update and disseminate them to all staff under the procedure “Management organization and responsibility” code: XX-QTQL-05.

5.5.2. Document storage and management

- The document storage must follow their type and be put in separate folders with identifiable signs for search in case of necessity.

- The person in charge of document storage shall decide the permission of document copy.

- The documents which are expired, no longer necessary or superseded must be sealed “EXPIRED” with specified date.

- The procedure for recovery and destruction of documents is similar to item 5.2.5.

- Are not the original or copy but without the red seal “COPY”.

- When distributing some uncontrolled documents, the form “Document distribution/recovery monitoring book” under the form No. XX-QTQL-01-BM03 if needed.

Write all information in the following relevant forms:

- National standard, 2012, medical laboratory – specific requirement for quality and capacity (TCVN7782:2012- ISO 15189:2012), Hanoi.

- World Health Organization, 2011, Laboratory Quality Management System - Handbook, Document and Record, p.190-196.

http://whqlibdoc.who.int/publications/2011/9789241548274_eng.pdf

- ISO 15189:2012, Medical laboratories - Particular requirements for quality and competence, 2012./.

 

EXAMPLE OF SAMPLE OF STANDARD PRACTICE PROCEDURE FOR DIRECT AFB STAIN

 

- Describe and guide the way to do the direct sputum testing for Acid Fast Bacilli (AFB) by Ziehl-Neelsen stain.

- To be applied at XX Laboratory Department - XYZ General Hospital

- The officer assigned to do this test must properly comply with the procedure.

- The quality controller and professional team leader must monitor the compliance with procedure and assess the laboratory result.

The Ziehl-Neelsen stain is the method using 02 staining chemicals as fuchsin red and methylene blue combined with decolorant (mixture of HCL acid and alcohol 96 °) for detection of AFB. This method is used to detect the microorganisms of Mycobacteriacae family as microorganisms with alcohol and acid resistant characteristics. They can survive in the environment with certain alcohol or acid content without losing their color when bleached with alcohol or acid

- Compound optical microscope with objective lens 100X, 10X

- Biosafety cabinet class 1

- Minute timer

6.2.1. Devices

- Glass slidewith translucent head

- HB pencil

- Plastic cup for containing sputum

- Disposable sputum smear spatula

- Specimen stain rack

- Microscope cleaning tissue

6.2.2. Chemical

- Fuchsin solution 0,3%

- HCL alcohol solution 3%

- Methylen solution 0,3%.

- Phenol antiseptic solution 5% or Javen 0.5%

- Immersion oil

6.2.3. Specimen:

- Sputum contained in a sterile clean plastic tube with lid.

- Apply the general safety measures when processing and testing the specimen under the procedure for laboratory safety with code XX-QTQL-10.

- Start up the biosafety cabinet at least 15 minutes before implementation.

- Arrange necessary devices in the biosafety cabinet.

- Choose the clean and unscratched glass slide. Dry the slide over the flame of spirit lamp to eliminate the oil on it and leave it cool.

- Use HB pencil to write the code of specimen on the translucent head of glass slide.

- Arrange the sputum container and glass slide in order to avoid confusion.

In the biosafety cabinet:

- Gently open the lid of sputum container, put the cap on its back on the stainless steel tray.

- Use the beveled head of spatula to smear the sputum and gently cut it by wiping the beveled side of spatula on the sputum container wall (note: use each spatula for each specimen)

- Close the sputum container.

- Put the spatula with specimen in the middle of slide and spread under the spirals from the inside out regularly and continuously to form an oval shape with size of 2 cm long and 1cm wide with the fineness and moderate thickness.

- Soak the spatula after spread into the antiseptic phenol solution 0.5% or Javel 5%.

Note: Only discarding the sputum container after returning the testing result.

- Put the specimen on the glass tray and leave it dry completely at the room temperature (18-25°C).

Note: Do not dry the specimen with spirit lamp or in the sun light.

- Do it outside the biosafety cabinet.

- Dry the specimen from side to side over the flame of spirit lamp for 3-4 times, 3 seconds for each time.

Note: Do not fix the specimen if it is not dry completely.

- Put the specimen on the staining rack

- Cover Fuchsin solution 0,3% on the fixed specimen smear side.

- Dry it over the flame of spirit lamp until evaporation (do not leave it boil) for 1 time.

- Leave it cool naturally in 5 minutes.

- Rinse it under light running water.

- Cover HCL alcohol solution 3%

- Leave the specimen in 3 minutes.

- Rinse it under light running water.

Perform the 2^nd discoloring (1-3 minutes) if the specimen is still pink

- Cover the Methylen solution 0,3% in 1 minute.

- Rinse it under light running water (note: do not put the specimen directly under strong running water).

- Leave it dry at room temperature.

- Examine the specimen with optical microscope with oil objective lens 100X as instructed in the manual for microscope with oil objective lens code XX.HD.03.

+ Positive: AFB is rod-shaped bacilli that are thin, somewhat curved, Fuchsin red absorbing, individually, in pairs or groups on blue background.

+ Negative: No AFB found

There are 06 standards as follows:

- Observation: specimen has no mucus, saliva and blood at best.

- Standard upon microscopic examination:

+ There are 25 polymorphonuclear leukocytes (examination of objective lens 10X, eyepiece 10X).

+ There are 3-4 polymorphonuclear leukocytes/microscopic field (examination of objective lens 10X, eyepiece 10X).

+ Or there are macrophages.

- Oval shape in the center of glass slide.

- 1cm wide and 1cm long.

- The surface of specimen has the continuity, regularity without hollowness or flaking.

- Examination: The microscopic fields have the continuity and there are not many hollow microscopic fields, regular brightness.

- The thickness of specimen is 0.04mm. Check by the way when the specimen is dry without staining, put a paper with letters 4-5 cm away from the specimen.

+ Satisfactory: if the words are fuzzy and readable.

+ Too thick: Illegible

+ Thin: Unclear

- Examine the depth of the specimen (bright blue microscopic field).

- If the specimen is too thick: Many layers, the microscopic field cannot be examined (dark blue microscopic field).

- If the specimen is too thin: Microscopic fields are sparse (light blue).

- Examination under microscope: AFB absorb red color clearly on blue background.

- Unsatisfactory: The specimen is still red with naked eyes.

- No dirty residue, Fuchsin residue, crystal… upon examination under microscope.

- If there are dirty residues, the reasons are the stain is left long or dried too long during the staining.

- Frequency of testing: daily or at least 1 week/1 time.

- Testing with a positive specimen to count the amount and color of AFB.

- Testing with a negative specimen to check if the stain and water source are infected with AFB.

- Write the result in the quality checking book.

Note: 01 line of glass slide is equivalent to 100 microscopic fields. Examine at least 3 lines.

- If AFB is light, it is because the discoloring was too long or the staining was not done sufficiently (time, heat).

- If AFB is dark, it is because the staining was too long.

- Each batch of stain should not contain 12 specimen which are placed at least 01 cm from each other.

- Write the result in the result answer sheet and the sputum testing result book for AFB.

- Keep the forms of QC sheet in accordance with regulations of Department

- Ministry of Health, Guidelines on tuberculosis management, Medical Publishing House, 2009.

- Ministry of Health, National Tuberculosis Prevention Program, Guidelines on standard practice procedure for Tuberculosis bacteria testing.