Quality assessment of computer-assisted semen analysis (CASA) in the andrology laboratory.

If quality is assessed with regard to computer-assisted semen analysis (CASA), the evaluation of seminal fluid in the andrological laboratory has to be considered. Three levels of quality assessment are generally accepted: structure, process and results. Quality of structure mainly concerns the quality of laboratory assessment, in particular the skill of the staff and the equipment used. The quality of the CASA system itself is difficult to assess. Process quality concerns the quality of performing a diagnosis. When the parameter settings of the CASA system and the handling of the sample are defined, the reproducibility of the CASA values is clearly better than that of the visual estimation of motility. CASA systems are also superior to other methods regarding the documentation of laboratory values, as all the values are obtained directly online. Result quality comprises the precision, reliability and reproducibility of measurement as well as the significance of values with respect to their biological relevance. Concluding from the definitions as quoted above and from reports of the literature it may be stated that: (i) in the dimensions of structure and process quality, CASA is superior to other methods of measuring sperm motility; (ii) the evaluation of results and quality of results, however, is highly problematic; (iii) CASA systems do not appear to be superior to the visual estimation of sperm motility with respect to the fertilizing capacity of spermatozoa; (iv) the guidelines of the WHO task force form a basis for sufficient process quality; (v) further efforts should actually focus not on the improvement of investigation technology, but on the improvement in the qualification of investigators.

[Incidence of nosocomial infections as an element of cost-conscious quality management of inpatient care]. / Erhebung nosokomialer Infektionen als Element eines kostenbewussten Qualitätsmanagements im stationären Bereich.

The prevention of nosocomial infections is a result of many variables in a wide range of architectural, personal and organisational decisions taken into account in modern hospital plannings. The frequency of nosocomial infections in a given period can be used as one possible indicator of outcome quality of our hospitals. Contrary to the frequently uttered claims of many experts, who demand for a continuous hygienic monitoring in hospitals [1;2;3;4], routine procedures have not been unanimously established until now. Assessment and evaluation of nosocomial infections seem to be anything but trivial. Purpose of the described pilot study at the University of Lubeck was the development and test of a set of practicable routines to early discover and assess nosocomial infections. Methods of epidemiologic evaluation have been implemented to grant a perpetuos hygienic monitoring even on a limited base of personal, structural and financial resources. In a next step, further adaptations and improvements are planned, thus making assessment and evaluation independent of central institutions.