Quality improvement training is crucial for improved laboratory standards

By Lydia Nakiire

I refer to your story entitled, "Clinics store fruit juice in blood bank", that was published in The New Vision, Thursday April 28, 2016. In the story officials from the Ministry of Health (MOH) and Kampala Capital City Authority (KCCA) inspected laboratories in City clinics the previous day and found that a number of them did not meet the required standards.

The inspection team found that some laboratory staff lacked the certificate of registration and others had not been licensed to practice. In addition, they did not comply with the laboratory code of conduct; and reagents, drinks and fruits were stored in the laboratory refrigerators. The inspectors found blood banks being used as changing and sterilization rooms. The inspectors closed 3 of the laboratories inspected because they did not meet the minimum required standards.

I found it rather strange and out of the ordinary for staff to store reagents, food and drinks in the blood bank because it raises concerns about safety of the laboratory personnel and the general public. Laboratory acquired infections can occur during the course of work or other laboratory related activities.

Food or drinks stored within the laboratory may be contaminated and a source of infection to the consumers. Recent evidence from a review of literature, The Flemish Agency for Care and Health showed that there were 309 laboratory acquired infections globally, 42% of which were food borne Salmonella bacteria. Laboratory acquired infections are a major public health concern because an infected laboratory personnel could increase the risk of transmission to the general public and to make it worse, such hospital acquired infections tend to be resistant to most common antibiotics.

Indeed, the United States Centers for Disease Control and Prevention (US CDC) reported an outbreak of Salmonella typhimurium in 2011, a common cause of food-borne illnesses, among laboratory workers. In an in-depth investigation of 32 people who became ill, the New Mexico department of health found that the organism involved in the outbreak was similar to the commercially available type that is used in some laboratories. This clearly suggests that laboratories can be a source of infections if not well maintained, and by keeping fruits or food in them, this doubles the risk of acquiring such infections.

Storing foods or drinks in the refrigerators together with reagents and blood packs is simply putting the lives of laboratory personnel on the firing line! In addition, this practice affects the storage temperature yet this is vital to the quality of blood stored in the blood bank. Use of the blood bank exclusively for storage of donor blood is one of the requirements for laboratories to pursue accreditation.

It is likely that many of the laboratory personnel are not well trained to guard against these risks or they simply lack skills in improving the quality of laboratory services. A recent program, implemented by the World Health Organisation office for the African region found that, if laboratory personnel are well trained and mentored in continuous quality improvement, there was a significant improvement in the performance of the laboratory.

 Based on the available evidence, urgent measures are needed to ensure continuous quality improvement of the laboratories not only in Kampala but across the country. In addition there is need to evaluate the quality improvement programs to assess effectiveness in improving performance of the Laboratories. The Ministry of Health, together with professional bodies such as Allied Health Professionals, should consider including the private practicing professionals in the quality improvement programs to protect the lives of laboratory personnel and the general public.

 The writer is a Public Health Fellow attached to the Ministry of Health – Public Health Emergency Operations Centre