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Since 1960, Williams and Trotman had dreamed of automating all technical manipulations in bacteriology. However, this switch to automation took several decades to realize. The high cost of instruments and the attachment to classical bacteriology were the main obstacles. Automation began with blood culture incubators, and paved the way for automation in other areas of bacteriology, notably cytology, culture, identification and antibiotic susceptibility testing. Medical laboratories have been quick to recognize the efficiency of these systems and their many advantages. The reduction in turnaround times for bacteriological examinations is one of the changes that have revolutionized laboratory practice. In addition, sensitivity, safety, traceability and quality are more assured with automation. The second revolution is the integration of artificial intelligence into the processing and interpretation of bacteriological analyses. We are currently witnessing the total automation of laboratories and a reduction in human intervention. In this article, we have attempted to address all aspects of bacteriology affected by automation, and the impact of this change on current laboratory practice and quality of healthcare.

Context: Implementation of quality management system (QMS) which encompasses various quality indicators (QIs), can serve as a stepping stone for continuous improvement & help in achieving globally accepted quality standards in a diagnostic laboratory., Aims: To generate preliminary data on trends of post-analytical QIs in Bacteriology section., Settings and Design: A pilot study was conducted at a tertiary care teaching hospital located in Rishikesh, Uttarakhand., Methods and Material: Data of the following four quality indicators pertaining to aerobic culture and sensitivity testing of various clinical samples received in Clinical Bacteriology laboratory was compiled and retrospectively analysed: (i) Rate of reporting errors; (ii) Rate of re-dos; (iii) Percentage of reports correlating with clinical diagnosis; (iv) Percentage of adherence to safety precautions by employees working in diagnostics., Statistical Analysis Used: Descriptive statistics like mean and frequency distribution plots., Results: The mean reporting error rate was 0.12 per 1000 tests. It was consistently low from July 2018 to May 2019, after which an overall increasing trend was observed. The mean rate of re-dos was 2.79 per 1000 tests. An overall decreasing trend was observed with maximum rates during the months of December 2017 and January 2018. On an average only 7.86% of the reports co-related with clinical diagnosis. Almost 100% adherence to safety precautions was observed with the exception of two instances of needle stick injuries (NSIs)., Conclusions: Commitment of laboratory personnel in adopting, maintaining and analysing QMS data will lead to further strengthening of our existing healthcare system., (Copyright © 2020 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Background: Access to clinical bacteriology in low resource settings (LRS) is a key bottleneck preventing individual patient management of treatable severe infections, detection of antimicrobial resistance (AMR), and implementation of effective stewardship interventions. We sought to demonstrate the feasibility of a practical bundle of interventions aimed at implementing sustainable clinical bacteriology services at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, and report on cost and intensity of supervision. Methods: Starting in Dec 2015, an intervention based on the CLSI QMS01-A guideline was established, consisting of (i) an initial needs assessment, (ii) development of key standard operating procedures, (iii) adaptation of processes for LRS, (iv) training and supervision of laboratory staff via consultant visits and existing online resources, and (v) implementation of a practical quality systems approach. A guiding principle of the bundle was sustainability of all interventions post implementation. Outcomes and challenges: An initial investment of ~US$ 26,200 for laboratory reagents, and a total of 50 visit-days per year from three Canadian and Norwegian microbiologists were committed. Twelve SOPs, including antimicrobial susceptibility testing, were adapted, and an automated blood culture platform was donated (bioMerieux). In the first 18 months of implementation of the intervention, the average volume of specimens analyzed in the lab went from 15/day to 75/day. The number of blood cultures tested increased from an average of 2/day to over 45/day. Antimicrobial susceptibility testing was introduced and cumulative antibiograms were generated for the institution. Quality control was implemented for all procedures and quality assurance tools implemented included external quality assurance and proficiency testing of six technologists with longitudinal follow-up. The laboratory is on the path toward SLIPTA accreditation by the African Society for Laboratory Medicine. Reagent costs, staff training and retention, and engagement of clinical personnel with the lab proved to be manageable challenges. Key external challenges include in-country supply-chain management issues, lack of competition among distributors, and foreign-currency exchange distortions. Conclusions: Using a relatively low-intensity intervention based on existing training tools and accreditation schemes, we demonstrate that establishment of reasonable-quality clinical bacteriology is not only within reach but also a critical step toward assessing the burden of AMR in settings like this one and implementing effective stewardship strategies., (Copyright © 2020 Yansouni, Seifu, Libman, Alemayehu, Gizaw, Johansen, Abebe, Amogne and Semret.)

There are various ways in which the names of prokaryotes can be duplicated in the literature. An examination of the various ways that this may happen under the International Code of Nomenclature of Prokaryotes indicates that a concept is missing, namely the one that refers to the same name based on the same nomenclatural type published in the International Journal of Systematic Bacteriology/International Journal of Systematic and Evolutionary Microbiology, by the same or different authors in different manuscripts or in the Validation Lists. To cater for such instances it would be appropriate to introduce the concept of the isonym and to regulate how they are to be dealt with.

The wording of Rule 40d was discussed at the XIIth International (IUMS) Congress of Bacteriology and Applied Microbiology, Istanbul in 2008 and some changes were made to clarify how the authorship of names covered by this rule were to be cited. However, a key topic that was raised and discussed was the issue of wording that either automatically creates a subspecies name or whether an automatic consequence of the rule was that a subspecies name based on the nomenclatural type of the corresponding species was required, but must be validly published in accordance with the Rules of the International Code of Nomenclature of Prokaryotes. The differences are subtle, but important.

Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Sir William Watson Cheyne is largely known to medical history as Lord Lister's 'trusted assistant'. 1 He spent a lifetime defending Joseph Lister's (1827-1912) antiseptic principle in the wake of scepticism and misunderstanding. However, his main contribution to Lister's work was in the embryonic field of bacteriology in the 1870s-1890s, which brought him into contact with continental researchers, particularly Robert Koch (1843-1910). In this field, Cheyne built an independent reputation as an assessor, chronicler and promoter of continental laboratory methodology. He pioneered bacteriological training in British teaching hospitals and incorporated laboratory testing into case notes as standard procedure. This paper reconsiders Cheyne's contribution to the development of bacteriology in British medicine at the end of the 19th century. It examines his motives in promoting new laboratory techniques and the methods he used to embed them in hospital procedure. It also considers how he continued to use bacteriological arguments to keep the Listerian antiseptic principle on the medical agenda well after Lister withdrew from active involvement in the field., (© The Author(s) 2015.)

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) include controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most relevant conclusions and lessons from the 2014 controls. As a whole, the results obtained in 2014 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. Once again, the results of the SEIMC program highlighted the need to implement both internal and external controls in order to assure the maximal quality of the microbiological tests., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Automation was introduced many years ago in several diagnostic disciplines such as chemistry, haematology and molecular biology. The first laboratory automation system for clinical bacteriology was released in 2006, and it rapidly proved its value by increasing productivity, allowing a continuous increase in sample volumes despite limited budgets and personnel shortages. Today, two major manufacturers, BD Kiestra and Copan, are commercializing partial or complete laboratory automation systems for bacteriology. The laboratory automation systems are rapidly evolving to provide improved hardware and software solutions to optimize laboratory efficiency. However, the complex parameters of the laboratory and automation systems must be considered to determine the best system for each given laboratory. We address several topics on laboratory automation that may help clinical bacteriologists to understand the particularities and operative modalities of the different systems. We present (a) a comparison of the engineering and technical features of the various elements composing the two different automated systems currently available, (b) the system workflows of partial and complete laboratory automation, which define the basis for laboratory reorganization required to optimize system efficiency, (c) the concept of digital imaging and telebacteriology, (d) the connectivity of laboratory automation to the laboratory information system, (e) the general advantages and disadvantages as well as the expected impacts provided by laboratory automation and (f) the laboratory data required to conduct a workflow assessment to determine the best configuration of an automated system for the laboratory activities and specificities., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. In this article, the most important conclusions and lessons from the 2009 controls are presented. As a whole, the results obtained in 2009 confirm the excellent skill and good technical standards found in previous editions. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. The results of this program highlight the need to implement both internal and external controls in order to ensure maximal quality of microbiological tests., (Copyright © 2011 Elsevier España S.L. All rights reserved.)

We have evaluated the methodological quality of the Rémic (microbiology guidelines - bacteriology and mycology) of the Société française de microbiologie (edition2007), using to AGREE criteria, which are consensual at an international level, in particular at the the World Health Organisation (WHO) and at the European Union. The methodological quality of the Rémic appears to be sub-optimal. These shortcomings in quality are mainly observed in AGREE domain n° 5 (applicability), in AGREE item n° 5 (patients' opinions were not considered), and in AGREE item n° 23 (conflicts of interest were not declared). The users of the Rémic must be aware of these few methodological shortcomings in order for them to be careful before they put its recommendation in practice. In conclusion, we advise the editors of the Rémic to insert at least a methodological chapter in their next edition.

The External Quality Control Program of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) includes controls for bacteriology, serology, mycology, parasitology, mycobacteria, virology and molecular microbiology. This article presents the most important conclusions and lessons drawn from the 2007 controls. As a whole, the results obtained in 2007 confirm the excellent skill and good technical standards found in previous years. However, erroneous results can be obtained in any laboratory and in clinically relevant determinations. A few deviations were observed in some controls, calling for critical reflection. Once again, the results of this program highlighted the need to complement internal with external controls, such as those offered by the SEIMC program.

The Judicial Commission of the International Committee on Systematics of Prokaryotes has decided to place the genus Methanothrix with the species Methanothrix soehngenii Huser et al. 1983 on the list of nomina rejicienda, based on the fact that it is not represented by an axenic culture and contravenes Rule 31a of the International Code of Nomenclature of Bacteria. The species Methanothrix thermophila is transferred to the genus Methanosaeta as Methanosaeta thermophila (Kamagata et al. 1992) Boone and Kamagata 1998 comb. nov.

The Judicial Commission affirms that typification of Lactobacillus casei is based on ATCC 393, that ATCC 334 is a member of a different taxon and that the publication rejecting the name Lactobacillus paracasei (and its included subspecies) together with the revival of the name 'Lactobacillus zeae' contravenes Rules 51b (1) and (2) of the International Code of Nomenclature of Bacteria.

Based on a list of 205 names proposed in original articles in the International Journal of Systematic and Evolutionary Microbiology or cited in Validation Lists from January 2001 that are not in accordance with Rules 27(3) and 30 of the International Code of Nomenclature of Bacteria (the Code), the Judicial Commission rules that names contained in lists 2-4 are to be considered to be validly published and that deposit in more than one collection in different countries is documented. Names included in list 1 are only to be considered validly published if evidence is presented that the strains have been deposited in additional collections, as laid down by Rules 27 (3) and 30 of the Code.

Several communities in Nigeria exist without regular water supplies of good quality and quantity. Despite this situation, successive governments have tended to ignore the problem. The water supplies to two rural communities 7-8 km north of Calabar, Cross River State of Nigeria, were examined bacteriologically using standard indicator bacteria (coliforms and streptococci). A contiguous community supplied with treated piped water was also studied in parallel. The rural water supplied was found to be bacteriologically unsatisfactory, having failed to meet the international standards for drinking water as set by the WHO. The geometric mean bacterial counts per 100 ml of serial samples from six sources ranged from 0.12 x 10(1) to 1.57 x 10(2) for fecal coliforms (E. col) and 0.05 x 10(1) to 7.5 x 10(1) for the fecal streptococci. Fecal streptococci were particularly recovered in large numbers from one source (Ayip Asikimangfuk) at concentrations of up to 3.0 x 10(2) per 100 ml at the onset of the rains. The water supplies from the community with piped water were, in general, bacteriologically satisfactory; fecal coliforms were found only in occasional samples (0.12 x 10(1)/100 ml).

From 1990 to 2000, the number of published named taxa based upon new isolates at species and genus levels in International Journal of Systematic and Evolutionary Microbiology, formerly International Journal of Systematic Bacteriology, have increased by approximately four- and sevenfold, respectively. New taxa based upon characterization of only a single isolate remained at around 40% for both categories. The Bacteriological Code (1990 Revision) has no recommendations on the number of strains required for definition of new taxa. For a few groups, a minimum number of 5-10 strains has been suggested in minimal standards. Since an exponential increase in new taxa can be expected in the future, the authors discuss problems related to naming new species and genera based upon descriptions of a single isolate and suggest that this practice is re-evaluated. It is proposed that the following should be added to Recommendation 30b of the Bacteriological Code: 'Descriptions should be based on as many strains as possible (minimum five), representing different sources with respect to geography and ecology in order to be well characterized both phenotypically and genotypically, to establish the centre (from which the type strain could be chosen) and the extent of the cluster to be named. In addition, comparative studies should be performed, including reference strains that represent neighbouring species and/or genera, in order to give descriptions that are sufficiently detailed to allow differentiation from these neighbours.'

In order to audit United Kingdom laboratory diagnostic and reference services including novel molecular methods for tuberculosis, a questionnaire was sent to laboratories submitting specimens to the PHLS Mycobacterium Reference Unit (MRU) and regional centres and to the Scottish Mycobacteria Reference Laboratory (SMRL) in 1996-7. Nationally, 67.2% of laboratories responded. Most UK laboratories were fully or conditionally CPA accredited and take part in the NEQAS proficiency scheme. On average only 3.3% of primary samples submitted for mycobacterial diagnosis in 1995 produced a mycobacterial culture from approximately half as many patients (that is, a mean of 1488 specimens producing 49 isolates from 23 patients). Potentially over 380,000 specimens are processed for mycobacteria in the UK each year. The majority of laboratories use 4% NaOH +/- NALC for specimen decontamination. Culture on solid media was used by most laboratories and 62.9% also use liquid media. Most laboratories incubated cultures for eight weeks. Few laboratories use molecular diagnostic methods. Laboratories were most likely to use molecular methods for diagnosing tuberculous meningitis and for specimens from immunocompromised patients, although usage was strongly influenced by cost. Within England and Wales 43.9% (47/107) and 56% (61/109) of laboratories wanted a rapid service for rifampicin resistance detection in M tuberculosis from immunocompetent and immunocompromised patients, respectively. In regard to a tuberculous meningitis service, 80.5% (43/112) and 84.3% (102/121) of laboratories wanted this service for immunocompetent and immunocompromised patients, respectively. The quality of reference services was rated as "very good"/"good" by 85.6% of respondents nationally. Rapid molecular amplification diagnostic services were established at the PHLS MRU for rifampicin drug resistance detection nationally and for tuberculous meningitis at the MRU.

Different strains of the Escherichia coli reference collection (ECOR) differ widely in chromosomal size. To analyze the nature of the differential gene pool carried by different strains, we have followed an approach in which random amplified polymorphic DNA (RAPD) was used to generate several PCR fragments. Those present in some but not all the strains were screened by hybridization to assess their distribution throughout the ECOR collection. Thirteen fragments with various degrees of occurrence were sequenced. Three of them corresponded to RAPD markers of widespread distribution. Of these, two were housekeeping genes shown by hybridization to be present in all the E. coli strains and in Salmonella enterica LT2; the third fragment contained a paralogous copy of dnaK with widespread, but not global, distribution. The other 10 RAPD markers were found in only a few strains. However, hybridization results demonstrated that four of them were actually present in a large selection of the ECOR collection (between 42 and 97% of the strains); three of these fragments contained open reading frames associated with phages or plasmids known in E. coli K-12. The remaining six fragments were present in only between one and four strains; of these, four fragments showed no similarity to any sequence in the databases, and the other two had low but significant similarity to a protein involved in the Klebsiella capsule synthesis and to RNA helicases of archaeal genomes, respectively. Their percent GC, dinucleotide content, and codon adaptation index suggested an exogenous origin by horizontal transfer. These results can be interpreted as reflecting the presence of a large pool of strain-specific genes, whose origin could be outside the species boundaries.

In 1991, we reported that 55% of laboratories participating in the Wisconsin Proficiency Testing Program could not accurately identify serum samples from Lyme disease patients containing antibody against Borrelia burgdorferi. The purpose of this study was to determine whether the accuracy of Lyme disease test results reported by approximately 500 participants in the Wisconsin State Laboratory of Hygiene/College of American Pathologists Lyme Disease Survey had improved. From 1992 through 1994, 50 serum samples were sent to participants of the survey. Each laboratory received 28 serum samples from individuals with Lyme disease according to the case definition of the Centers for Disease Control and Prevention and 22 serum samples from healthy individuals. Unfortunately, the serodiagnosis of Lyme disease by participants had not improved. The specificity of the Lyme disease assays steadily decreased from approximately 95% to approximately 81% during the 3-year period of the survey. False-positive test results approached 55% with some of the serum samples from healthy donors. A serum sample containing antibody against Treponema pallidum was reported as positive by 70% of the participants. In addition, the sensitivity fluctuated between 93 and 75%, depending upon the conjugate used by the laboratories. These results suggest that stronger criteria must be applied for approving and continuing to approve commercially available kits for the serodiagnosis of Lyme disease.

In the action undertaken for evaluating of the reliability of serological tests for M. pneumoniae infection 33 laboratories of the Sanitary Epidemiological Stations participated. Every laboratory had to determine twice at an interval of 2-4 weeks the level of mycoplasma antibodies by the complement fixation test in serum samples divided into 4 groups: sera not containing these antibodies-titre < 5, or containing them in titres of 60, 120 and 320. The correct results of the determinations were obtained in 27 laboratories (81.8%) for samples without M. pneumoniae antibodies, and in 22 (66.6%) and 14 (42.4%) for samples with titres of 60 and 120, and 320 respectively. Only 4 laboratories (12.1%) obtained correct results of these determinations for every sample and in both testing series. In these series considered separately correct results were obtained in 9 (27.3%) and 8 (24.2%) laboratories. Faulty results in all samples in both testing series were reported from 2 (6.1%) laboratories. In the individual series all false results were obtained in 4 (12.1%) and 3 (9.1%) laboratories. The study showed that for raising of the quality and reliability level of serological investigations for M. pneumoniae infection a permanent practice should be periodic training of laboratory workers and frequently repeated interlaboratory controls of the reliability of test results.

By using the assessment, policy development, and assurance model to describe the functions of public health, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) is shown to be responding to the laboratory aspects of tuberculosis detection, prevention, and control. The many activities described illustrate the value of public-private partnerships in addressing population-based, public health threats. The network of state and territorial public health laboratories, through voluntary involvement in ASTPHLD, provides an important resource to the scientific, educational, and policy-making community.

In conclusion, the components of QA (QC, QI, and PT) in the mycobacteriology laboratory address not only the accuracy of testing but also provide a measure for the laboratory practices that are necessary to effectively diagnose and control tuberculosis in the community. Given the extremely important role of laboratory testing in the control of tuberculosis, providing rapid diagnosis and determination of susceptibility test results, laboratories should use the recommendations concerning turnaround times as either achievable goals or a measure of whether the laboratory should be performing mycobacteriology tests. We strongly urge laboratories to include their turnaround times for test results and the timeliness of reporting those results in their annual QA program.

Tuberculosis causes more deaths worldwide than any other single infectious disease. Most new cases occur in developing countries, where the emergence of HIV/AIDS-associated multidrug-resistant Mycobacterium tuberculosis could disrupt the effective delivery of chemotherapy. Diagnosis, one of the cornerstones of the modern national tuberculosis control programs in developing countries, is based on sputum smear microscopy, which can be delivered effectively only through a national laboratory network. Tuberculosis diagnostic services can be delivered in lock step with the expanding laboratory network in an incremental manner, beginning with the simplest procedure and ending with the most sophisticated ones.

This article presents an expanded agent summary statement for laboratorians working with Mycobacterium tuberculosis. It focuses on reducing the serious risk of infection in clinical laboratories that process specimens from tuberculosis patients or that work with purified cultures of tubercle bacilli. Administrative and engineering controls, practices and procedures, and personal protective equipment are discussed. Guidelines for packaging specimens for transfer to another laboratory also are presented.

Aim: To develop an internal quality assessment (IQA) scheme in a clinical bacteriology laboratory., Methods: Over 24 months, 1230 diagnostic specimens, representing 0.42% of laboratory workload, were anonymised and resubmitted for analysis. Six hundred and twenty one (48.7%) of these gave positive culture results; 44 fecal and upper respiratory specimens were "spiked" (artificially inoculated) to increase the proportion of positive samples., Results: Discrepancies between IQA and clinical sample results occurred in 188 cases (14.8%): 76.6% of these were in culture results, 13.3% in microscopy performance, and 10.1% in clerical recording. The culture discrepancy rate for each positive sample was lowest for wound (17.5%) and urine (18.1%) specimens, and highest for faeces (34.9%) and upper respiratory (37.7%) samples. Discrepancies in several areas responded to staff training and improvement in technical methods., Conclusions: An IQA programme of this type assesses the reproducibility of tests within a diagnostic laboratory when analysing common specimen types and organisms. It permits blind assessment of many areas of diagnostic work that are not readily amenable to other quality assurance methods, and it raises the awareness of all staff to the importance of quality in every aspect of specimen and data processing.

The description of Corynebacterium striatum (Chester 1901) Eberson 1918AL in Bergey's Manual of Systematic Bacteriology has many inconsistencies with the identification scheme from the Centers for Disease Control and Prevention. We have studied the four C. striatum reference strains available from the American Type Culture Collection and the National Collection of Type Cultures and found that they fit the Centers for Disease Control and Prevention description of this species. However, it appears that the wrong strains were deposited for this species, because none of the reference strains fits the descriptions in the original publications. This is a substantial case for declaring it a nomen dubium, but the name could be rescued if a careful search reveals a strain that was used in making the original description. It is hoped that some readers may have the missing strains labeled with the early names Bacillus striatus, Bacillus flavidus, or Corynebacterium flavidum.

The objective of this study was to evaluate the technical quality of sputum microscopy carried out for diagnostic purposes in the Network of Tuberculosis Bacteriology Laboratories in Colombia. The National Central Reference Laboratory received 6,529 slides for reexamination from the network of 513 sectional, regional, and local laboratories, which contributed 33.2%, 27.6%, and 39.2%, respectively, of the slides. These included all the positive (3,283) and negative (3,246) smears processed during a 4-month period. The reexamination was carried out by six laboratory workers who did not know the origin of the slides or the original diagnosis. When qualitative problems were detected, a second reexamination was done, which significantly increased the percentage of agreement for both the positive results (93.9%) and the negative (98.7%). Overall, the level of agreement was 96.3%. A significant correlation was found (P < 0.05) between good slide preparation and staining and agreement in the readings, as well as between thin smears, presence of fuchsin precipitates, and deficient coloration and conflicting readings (P < 0.05). The highest percentages of agreement were associated with laboratories that performed the largest number of sputum examinations each month (96.5%), and with readings done by experienced, university-trained bacteriologists (96.6%). It is concluded that indirect technical supervision and ongoing training of laboratory personnel are important determinants of the impact of the tuberculosis control program.

In Hungary, uniform methods and quality assessment date back as early as 1927, when the National Institute of Hygiene and regional public health laboratories were established. The National Microbiology Committee organized in 1984 was replaced in 1992 by the National Clinical Microbiology Board and the Joint Quality Assurance Committee of Clinical Microbiology for which the National Institute of Hygiene acts as an operating centre. A long-range programme of proficiency testing and on-site inspections had a beneficial effect on performance in public health laboratories: in 1989 20 out of 24 of them were scored in the excellent or good degree. Hospital laboratories, which joined this programme only in 1984, exhibited less satisfactory results.

Aims: To assess the efficacy of a bacteriology service in respect of the time interval between collection of specimen and receipt of final report using the number and type of incoming telephone enquiries as a proxy measure., Methods: For three months, all incoming telephone enquiries regarding the results of bacteriology specimens were monitored. Specimen type, date of sampling, the sender's location and the reason for making the telephone enquiry were recorded., Results: The number of telephone enquiries made during the study was 1170, about 5% of the total number of samples received. Most enquiries related to results of urine cultures. These accounted for 33.9% of the calls, but only 5% of the total number of urines cultured. Enquiries relating to blood cultures were the next largest group accounting for 14.9% of calls, but 11% of the blood cultures received resulted in a telephone enquiry. The most frequent reason for making the telephone call was that the sender had not received the final report., Conclusions: Clinicians may have unrealistic expectations of the time taken to examine a specimen. A requirement for reporting sterile blood cultures after a shorter incubation period was found, and the value to patient management of earlier reporting of negative urine samples was identified.

The cost effectiveness of quality control in bacteriology stipulated by regulators is not established. The authors evaluated 111 surveillance procedures applied to 54 different operations; 100 had been performed in the authors' lab between 1965 and 1980, 91 of which had been performed 50 times. Forty-six conformed to CLIA requirements (CLIA-P). Thirty-seven others were CLIA-P, which had been modified (CLIA-PM) by reducing frequency and extent because few or no deficiencies had been observed. Eight others were devised by the authors (HH-P). The number detecting deficiencies, the per cent, and the mean per cent of deficiencies detected were: CLIA-P, 31, 67%, 3.5%; CLIA-PM, 8, 22%, 2.1%; HH-P, 8, 100%, 8.8%. Compliance with CLIA would cost HH $20,700/year (3.4% of total bacteriology laboratory cost). HH-P would cost an additional $9000/year. Discontinuation of CLIA-P not detecting deficiencies would reduce HH costs by $2900/year. Application of other low yield CLIA-P only to new lots of selected dehydrated media and fresh batches of selected reagents would reduce cost further by $2000/year.

A comprehensive microbiological quality assessment scheme for the benefit of all clinical microbiological laboratories in the United Kingdom was established in 1974. The main emphasis of the scheme has been on the supply of simulated clinical material for proficiency testing. Of 494 laboratories currently participating in the scheme, 84 are abroad and over 500 specimens have been distributed between 1974 and 1980. A wide variety of specimens are issued. These include specimens for: general bacteriology including isolation, sensitivity testing and serology; mycobacterial bacteriology; syphilis serology; virus isolation; general viral serology; rubella serology; hepatitis B antigen detection; electron microscopy; mycology; parasitology; antibiotic assay; public health specimens including milk and water. Laboratories are requested to examine the specimens using their routine procedures and report their results to the Microbiological Quality Control Laboratory (MQCL). The reports are analysed at MQCL and the summarised results of each distribution are sent to all participants. Each participant receives details of his individual performance on current specimens and an analysis of the previous 6 months, cumulative performance. The performance of all laboratories is reviewed twice yearly and laboratories with results significantly worse than those of their peers are offered the opportunity to seek advice and help from a National Advisory Panel of their professional colleagues. The Scheme is confidential and its main role is educational.