降低抗酸菌染色污染率

Reducing the Contamination Rate of Acid Fast Bacilli Staining

「採檢」是一個檢驗流程的開始，正確檢體採集以避免檢體遭受污染。醫師與病患要獲得一份準確的檢驗報告，從檢體的採集開始，每一步驟都馬虎不得，否則再有精密的儀器、再精湛的檢驗技術，也徒勞無功。酸性染色(Acid-Fast Stain)主要用來初步鑑定分枝桿菌 (Mycobacteria)的存在。檢體種類經常是痰液、體液、組織及菌落等，其中以痰液的抗酸性染色使用最頻繁，可做為分枝桿菌感染的初步評估；惟本研究發現個案醫院之抗酸菌染色污染率卻達25%，始至其檢驗之信、效度皆將造成顯著性影響，醫療服務品質身受考驗。本研究於2010年1月成立專案小組，以QCC手法，期降低抗酸菌染色之污染率，2010年2月分析個案醫院之抗酸菌染色污染原因主要為（一）病人採檢方式不正確；（二）試劑脫色時間太短；（三）檢體盒蓋子未蓋緊；（四）玻片不乾淨。經本研究1個月之專案改善措施，內容包括（一）給予衛教單且避免制式化衛教及印製雙語衛教單；（二）薄塗片縮短脫色時間，厚塗片延長脫色時間；（三）第一線人員收件時，再次檢查盒蓋；（四）塗片時拿玻片四周。本研究執行结果顯示抗酸菌染色污染率由25%降至7%，達成率為127%，進步率是72%，成效顯著可有效改善抗酸菌染色污染率，不僅人員執行過程報告時效不變、偽陰性報告降低、成本控制良好，確實可提升更完善的實驗室檢驗品質。

Sampling' is the beginning of a test process. The correct specimen collection is to avoid contamination of samples. For physician and patient to get an accurate inspection report, each step of the collection of samples must be careful. Otherwise, a precise instrument or outstanding inspection techniques would be to no avail. Acid-Fast Stain is mainly used to initially identify the existence of mycobacteria. Types of samples are often sputum, body fluid, tissue and colony, of which the sputum acid-fast staining is most frequently used. It can be used as a preliminary assessment of mycobacterial infections. However, this study found that contamination rate of acid-fast bacilli staining in the case hospital amounted to 25% so as to result in significant impact on the reliability and validity of the test. The quality of medical services was seriously challenged. A special section was established in January 2010 for this study. By way of the QCC approach, it was expected to reduce the contamination rate of acid-fast bacilli staining. In February 2010, the analysis of the acid-fast bacilli staining in the case hospital indicated that the pollution was mainly due to (a) The patient specimen collection method was not correct. The reagent bleaching time was too short. (b) The lid for the samples was not tightly shut. (c) The slide was not clean. After the study processed a one-month special improvement project which includes (a) Distribute health education handouts. Avoid standardized health education. Print bilingual health education handouts. (b) A thin smear shortens the bleaching time. A thick smear extends the bleaching time. (c) Double-check the lid as the first-line personnel accept the samples. (d) Carry the smear slide by touching the edges only. The execution of this study showed that the contamination rate of the acid-fast bacilli staining was reduced from 25% to 7%. The accomplishment rate was 127%. The progression rate was 72%. The significant impact can effectively improve the contamination rate of the acid-fast bacilli staining. The staff report on the implementation process is not delayed. The false, negative reports decrease. The cost is under control. It can indeed enhance the perfect quality of laboratory inspection.