Integrated Analysis of Quality Use of Pathology Program (qupp) Final Reports

Evidence-Based, Best-Practice Prevention of Blood Borne Virus Transmission in Health Care Settings Program (PBBV) (2009)

Description

This project sought to develop specific laboratory guidelines and recommended procedures (the Guidelines) to ensure best practice in dealing with suspected cases of Blood Borne Virus (BBV) transmission in health care settings and thus reduce the likelihood and impact of BBV transmission.

Grant Recipient

South Eastern Area Laboratory Services (SEALS)

Aims and Objectives

• 
  to develop specific laboratory guidelines and recommended procedures to ensure best practice in dealing with suspected cases of BBV transmission
  
• 
  to create an Australia-wide forum for discussion of the guidelines
  
• 
  to identify facilities in each State for molecular epidemiology investigation studies
  
• 
  to advise public health professionals, pathologists (including the Royal College of Pathologists of Australasia [RCPA]) and policy makers on the best-practice evidence-based laboratory procedures in dealing with these cases
  
• 
  to interface with health care workers and the community at large on basic information on BBV transmission via consultation, website and collaboration.
  

These aims and objectives appear to have been achieved. The report states some were still in progress of when it was tabled, specifically to continue developing guidelines and methods for testing and investigation, and to develop evidence-based models and analysis of protective factors for BBV infection.

Outcomes

• 
  Laboratory guidelines were developed comprising five sections:
  
  1. 
     principles for outbreak investigations
     
  2. 
     specimen handling, transport and storage
     
  3. 
     testing protocols for BBV investigations
     
  4. 
     BBV genotyping and sequencing
     
  5. 
     laboratory requirements for BBV investigations.
     
• 
  A draft of the BBV website was instigated which is an educational blog designed to provide an open forum for discussion on community issues related to BBV, particularly in the area of laboratory testing.
  
• 
  Specific BBV facilities were identified in four major States for molecular epidemiology investigation studies.
  
• 
  Development of an educational website for health care workers and the community on basic information on BBV transmission. This was under construction at the time of the report at: http://www.bloodborneviruses.org.au/.
  

Recommendations

1. 
   Continue development of guidelines and methods for testing and investigation, including reverse transcription polymerase chain reaction (RT-PCR) and sequencing protocols for the molecular epidemiology of BBVs to maintain these BBV facilities as a model of best practice in the investigation and prevention of BBV transmission.
   
2. 
   Develop evidence-based models and analysis of protective factors for BBV infection. This will result in the development of practical policies for BBV transmission and prevention in health care settings (liaison had already been established with PathWest, Victorian Infectious Disease Reference Laboratory [VIDRL] and NSW Health).
   

Key Project Learning

• 
  The main difficulty was meeting deadlines set by the Australian Government Department of Health and Ageing due to the swine flu pandemic. Most virology experts and infectious diseases committees were unavailable due to urgent issues related to the pandemic.
  

Follow on Initiatives and Projects

• 
  Integration of protocols to National BBV Testing Policies.
  

Risk Minimisation

Risk minimisation in pathology practice, from collection of a sample to reporting the results, is paramount to the quality use of pathology. The Quality Use of Pathology Program (QUPP) has sought to augment the solid basis in risk minimisation built by multiple stakeholders such as the Royal College of Pathologists of Australasia (RCPA), the RCPA Quality Assurance Programs Pty Ltd (RCPA QAP) and the National Association of Testing Authorities (NATA) through five projects (Table 3).

Key areas in risk minimisation include identifying early warning signs that can identify poorly performing laboratories, and assisting pathology laboratories to identify, measure, monitor and investigate potential or actual errors which may pose a potential risk to patient safety. These projects also highlighted some key project learnings regarding strategies to monitor, measure and assess laboratory performance, and highlighted the significant challenge that the majority of errors (75%) in pathology occur outside of the of the pathology laboratories’ control.
Based on these learnings, areas for future consideration from all reports summarised in this chapter include:

• 
  Standardise key definitions and terms for incident monitoring and reporting.
  
• 
  Consider strategies to address the issue of errors occurring when a non-pathology person collects a pathology sample.
  

	Project Name	Grant Recipient/s
1	RCPA – Quality Assurance Programs Key Indicator Project (2004)	Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP)
2	Pilot Laboratory Assessment and Peer Review Mechanism for Pathology Key Performance Indicators (2007)	RCPA QAP
3	Performance Monitoring of External Quality Assurance (Current)	RCPA QAP
4	NATA File Audit – Risk Analysis of Assessment Non Conformances Identified in Pathology Laboratory Assessment Accreditation (Current)	National Association of Testing Authorities (NATA)
5	Key Incident Monitoring & Management Systems (Current)	RCPA QAP

Table 3: Reports summarised for Risk Minimisation