The purpose of this paper is implementing internal audits in a surgical pathology laboratory. These audits are required for the new Belgian law about the quality system in surgical pathology laboratories. The law required that internal audits need to be conducted for all the paragraphs in the praktijkrichtlijn, within a timespan of five years. No internal audits where conducted for the first three years because of management changes and the work that needed to be done to the quality system. An external audit was performed to get an idea of the current situation of the quality system.
For the implementation, personnel have to be formally authorized to conduct internal audits. This can be done with internal or external education. A five-year audit plan needs to be crafted, preferably a plan that can be used as a template for the upcoming years. The procedure for internal audits must be developed. This must happen within the boundaries of the law. The first audits need to be conducted and evaluated. Finely, the corrective measures need to be arranged and followed. All these steps must be well documented and archived so progress of the audits can be checked.
All personnel follow a supplementary training and half of the personnel is now fully authorized to conducted internal audit, with the other half soon to follow. Two five-year audit plans are made. The first one is a short-term planning, the audits that need to be conducted in five years are now done in 2 years. The second planning is made so it can be used as a template for the upcoming years. The procedure for internal audits is written and was succesfully used in both internal audits. The audits found a large non-conformity in the system and did this without interrupting the workflow too much. The corrective measures are drawn-up for the first audit but could not be followed-up because of the time limit of this paper.
The implementation of the internal audits at the surgical pathology laboratory of AZ Zeno is successful. All personnel are authorized to conduct internal audits or will be in the first few months. A functional template was made for the required five-year audit plan. The procedure doesn’t disrupt the workflow too much. The effectiveness of the audits is proven by the non-conformities that are found and corrected. The corrective measures are drawn-up but the full cycle of the internal audits would need to be evaluated in a few years.
The aim of the study was to determine the prevalence of Clostridium difficile carriers within the residents of the WZC in our region.
Asymptomatic C. difficile colonization is the condition where in C. difficile is detected in the absence of symptoms. It is assumed that most of these carriers are protected against progression to a real infection by a humoral response against the toxins. However, they can act as a reservoir and can pose a risk to other persons. The primary routes of transmission are the faecal-oral route and direct contact with contaminated surfaces. (Furuya- Kanamori et al., 2015)
Obviously, in the nursing home population group a lot of people carry one or more risks. For this reason, this study was also set up. In the opinion of the Superior Health Council 8365, May 2008, states that the prevalence of C. difficile infection in Nursing homes varies between 2.1 and 8.1% (Simor et al., 1993).
Another recent study in Germany shows a prevalence of carriage of between 0 and 10 % between the various Nursing Homes (Arvand et al., 2011).
A letter of participation was sent to the heads of WZC's on the east coast of Belgium. 302 faeces were received. The data of the residents were not disclosed. The faeces came into the lab the day of collection. If it was not possible, they were stored in the WZC's at 4 ° C in the refrigerator. Once the faeces had arrived in the lab, the samples were stored in the refrigerator. If the tests could not all be performed on the same day, the samples were stored at -20 ° C in the freezer. During the study, each sample was tested with four different standard methods. Namely CerTest the Liaison® XL DiaSorin, mini VIDAS® and culture of bioMérieux. For culture soils Clostridium agar base and ChromID™ agar base were used. All data was recorded in an Excel file, as well as on paper. First, the CerTest was performed. Then the tests followed the Liaison® XL and mini VIDAS®. While waiting for the results of the Liaison® XL and the mini VIDAS®, the cultures were inoculated. When this was done, the faeses were frozen at -20 ° C to await the result of the culture. A sample which gave a negative result by all methodes, was thrown in the hazardous medical waste. The positive samples and with unconformity remained in the freezer.
A positive culture was confirmed with the Microflex™. When it gave any positive toxine result, the colonies were kept alive by seeding and incubating them again in an anaerobic environment. With any positive result a PCR was performed on the GeneXpert®. Any positive results were sent to the reference laboratory of C.difficile at UCL. Five occupants of the 302 persons examined in our study were carrying a toxigenic C.difficile, which corresponds to a prevalent of 1.7 %. No tribe belonged to the virulent Ribo-027 type.
The investigation showed quickly that we were dealing with, if any, weak concentrations. In co-operation with the national reference center UCL we decided to make use of a thioglycolate enrichment agar base.
144 of the 297 negative samples were inoculated and incubated for 10 days. After inoculate the Clostridium plate showed one sample to be extra positive to a toxigenic C.difficile, confirmed by the geneXpert®, Ribo-027 negative.
There can be concluded that the prevalence of carriers of toxigenic C. difficile in the Nursing Homes on the East Coast is 2.3 %.
To measure the sensitivity, positive CPE will be used on both the CRE Agar and ChromID® plates. This test determined whenever the positive CPE will be detected on the plates or not. There will be two test to conduct the sensitivity, the normal and the adjusted one.
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