External Quality Assessment in Microbiology. Pitfalls and Tips

The External Quality Assessment (EQA) is mandatory for the accreditation of medical laboratories. In Romania, this is a requirement of the National Insurance House based on the 1301/2007 Order of the Ministry of Health. Besides, the EQA providers must be accredited according to the specific standard ISO 17043:2010. Some issues can be considered as pitfalls when referring to the full and correct implementation of EQA requirements. It is important to acknowledge them and to know how to overcome them. Some of these pitfalls are presented and the ways in which they can be solved are discussed, as follows: the selection and the monitoring of the EQA provider; the real needs of the laboratory in terms of frequency, type of scheme, number of samples; the way in which the performance of the total testing process is assessed and the means of presentation of the results of the assessment. For microbiology EQA, additional important aspects are isolation or identification of the microorganisms with or without clinical significance, inhomogeneity and short stability of the samples, testing of appropriate antimicrobials, detection of the antimicrobial resistance mechanisms, detection of critical or borderline levels of antibodies, antigens or nucleic acids. Laboratory types (for inpatients or outpatients, for infectious diseases, general hospitals, for public health surveillance or for reference activities) should be taken into account when comparing the performance of each laboratory with overall performance. The EQA is a useful tool for continuous quality improvement, knowledge and experience playing a major role.