Blood culture quality assurance: findings from a RCPAQAP Key Incident Monitoring and Management Systems (KIMMS) audit of blood culture performance.

Blood cultures (BC) are the gold standard investigation for bloodstream infection. Standards exist for BC quality assurance, but key quality indicators are seldom measured. The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) Key Incident Monitoring and Management Systems (KIMMS) invited laboratories for the first time to participate in an audit to determine adult BC positivity rates, contamination rates, sample fill volumes and the proportion received as a single set. The overall aim of the KIMMS audit was to provide laboratories with a mechanism for peer review and benchmarking. Results from 45 laboratories were analysed. The majority of laboratories (n=28, 62%) reported a positivity rate outside the recommended range of 8-15%. Contamination rates ranged from zero (n=5) to 12.5%, with seven laboratories (15%) reporting a contamination rate greater than the recommended 3%. Fifteen laboratories (33%) reported an average fill volume of less than the recommended 8-10 mL per bottle, with 11 laboratories (24%) reporting fill volumes of 5 mL or less whilst 13 (28%) laboratories were not able to provide any fill volume data. Thirteen laboratories (29%) reported that 50% or more of BC were received as single set, and eight (17%) were not able to report this data. This audit highlights there are deficiencies in BC quality measures across laboratories. To support BC quality improvement efforts, RCPAQAP KIMMS will offer a yearly BC quality assurance audit to encourage laboratories to monitor their BC quality performance.

Review of current incidents and risk calculations used in the Royal College of Australasian Pathologists Key Incident Management and Monitoring Systems - a system that could be used by all Australasian medical laboratories, and easily adapted to worldwide use.

INTRODUCTION: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) Key Incident Monitoring and Management Systems (KIMMS) program has found that some existing Quality Indicators are too broad or not well defined. The risk matrix in use does not allow changes in incident Detection or Probability. In 2020, a review was performed: what issues should KIMMS include as Key Incidents and how could risk measurement be improved? MATERIALS AND METHODS: Twenty-seven networked and stand-alone laboratories enrolled in KIMMS during 2020 were surveyed on 45 current and new indicators of risk in the total testing process. They were asked which indicators they considered were significant in causing patient harm. Existing risk matrices in use by members of the KIMMS Advisory Committee laboratories were reviewed regarding their size or structure (3x3 or 5x5) and the descriptions of consequences and probability. RESULTS: Thirteen participants indicated 21 indicators should be monitored, and the KIMMS Advisory committee added a further 13 (11 from the remaining 24 and 2 new). Of the five risk matrices reviewed, all consistently used a 5x5 matrix to estimate Consequences vs Probability of harm. The KIMMS advisory committee added a third parameter to the calculation of Risk, Detectability. CONCLUSION: All 34 pre- and post- indicators should be monitored, covering all aspects of the total testing cycle other than analytical. The risk measurement can be improved by introducing a 5x5 risk matrix to evaluate harm (consequences x probability) and then evaluating risk by adding detectability; risk equals harm x detectability.

Unsaturated iron binding capacity and transferrin saturation are equally reliable in detection of HFE hemochromatosis.

OBJECTIVE: Unsaturated iron binding capacity (UIBC) has been proposed as an inexpensive alternative to transferrin saturation for detection of hereditary hemochromatosis. The aim of this study was to compare, in a hospital referral clinic, the reliability of transferrin saturation and UIBC for detection of subjects who have inherited HFE (HLA-asociated iron overload) genotypes predisposing to iron overload. METHODS: Serum transferrin saturation, UIBC, and ferritin were tested in 110 consecutive subjects. Optimum thresholds were determined from receiver operating characteristic curves. RESULTS: Of 110 subjects, 44 carried significant HFE mutations (C282Y/C282Y or C282Y/H63D). In genetically predisposed subjects with biochemical expression, the optimum threshold for transferrin saturation was 43%, giving a sensitivity of 0.88 and specificity 0.95. For UIBC, the optimum threshold was 143 microg/dL (25.6 micromol/L), giving a sensitivity of 0.91 and specificity of 0.95. In patients referred with a family history or clinical suspicion of hemochromatosis, transferrin saturation and UIBC were highly reliable predictors of genotype. In patients referred for investigation of abnormal liver enzymes without a known family history of hemochromatosis, a normal transferrin saturation or normal UIBC was highly reliable in excluding hemochromatosis. CONCLUSIONS: Transferrin saturation and UIBC have equal reliability in ability to predict hemochromatosis. UIBC should be considered as an alternative to transferrin saturation in detection of hemochromatosis.