DYNAMICS AND MANAGEMENT

OF POOR RESULTS IN RoEQALM

EXTERNAL QUALITY CONTROL
SCHEMES IN PARASITOLOGY,
DURING
2009-2013
Suzana Elena Cilievici
RoEQALM, Romania
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Colentina Clinical Hospital, Bucharest, Romania
RoEQALM External Quality Control Scheme
in Parasitology

l has started with mono-programs from

September 2002 until November 2006
l from February 2007 until present, has
continuities with both, mono-programs
and multiple- programs (4 times/year)
l The scheme of External Quality Control in
Parasitology is a qualitative nominal one

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 The participant laboratories has received:

l Control specimens of preserved stool

(formalin)/ control slides of thin/ thick blood
smear
l Information about the patient
l A printed form for the answer

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Information about the patient - contain
guide marks for the diagnostic
orientation
l History of travel
l Origin of the patient
l Occupation, age (risk groups)
l Clinical significant data (fever, abdominal pain,
diarrhea, splenomegaly, lost of weight)
l Laboratory data: degree of eosinophilia/ anemia/
thrombocytopenia)

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The printed form for the answer has
columns for each item:

l Number identification of the participant

laboratory
l Number identification of specimen control
l Results:
complete name of the species identified
specific stage
l Signature and stamp of the examiner

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The participant laboratory received finally:

l The confidential Evaluation Report

l The External Quality Control Certificate

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The confidential evaluation report
contain:
l The correct answer: complete name of the
parasitic organisms and the stages in
control sample/ control slide.

l Information regarding the answers of the

other participants.

l Suggestions/comments.
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Responses are considered to be:

l correct if the participant identified correctly the parasitic species

present in the control sample, as well as the corresponding
evolutionary stage.

l acceptable if the participant identified correctly only the

parasitic species in the control sample, but not properly the
evolutionary stage or has shown additionally species
nonexistent in the control sample.

l incorrect (poor results) if the participant has incorrectly

identified both the parasitic species and evolutionary stages in
the control sample.

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2009: 97 participants
02/2009 Plasmodium ovale 04/2009: Plasmodium malariae
100 100

50 11% Est 3%
50
14% Est
Vest
Correct
Acceptable
Vest
Correct
Acceptable
31% 0 Incorrect 0 Incorrect

Trim Trim
58%
Nord Trim Trim Nord
83%

1 3 1 3

09/2009: Strongyloides stercoralis 10/2009: Plasmodium falciparum, Plasmodium ovale

100 100

50
15%
6% Est 50 Est
41%
Vest
Correct
Acceptable
Vest
Correct
Acceptable
0 Incorrect 0 Incorrect

Trim Trim Nord Trim Trim

56%
Nord
79% 3%

1 3 1 3

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2010: 97 participants
03/2010: Schistosom a m ans oni 04/2010: Plasmodium falciparum
100 100
22%
5014% 29%
Est 50 Est
6% Correct
Correct
Vest
Acceptable
Vest
Acceptable
0 Incorrect
0 Incorrect

Trim Trim Nord Trim Trim 72% Nord

57%

1 3 1 3

09/2010: Taenia spp, Clonorchis/Opistorchis spp 10/2010: Strongyloides stercoralis, Hookw orm s
100 100

50 6%
30%
Est 50
21% 7%
Est
Correct Correct
Vest
Acceptable
Vest
Acceptable
0 Incorrect 0 Incorrect
Nord Nord
64% Trim Trim Trim Trim72%

1 3 1 3

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2011: 74 participants
03/2011: Hym enolepis nana, Clonorchis /Opis torchis s pp 04/2011: Ascaris lum bricoides, Trichuris trichiura,
100 100 Hookw orm s

50
7%
8% Est 50 11% 0% Est
Vest
Correct
Acceptable
Vest
Correct

0 Incorrect 0 Acceptable

Trim Trim85% Nord Trim Trim Nord

Incorrect

1 3 1 389%

09/2011: Iodamoeba, Blastocystis hominis 10/2011: Trichuris trichiura, Hookw orm s

100 100
5%
50 Est 15%
50 Est
43%
Correct Correct
Vest
Acceptable
Vest
Acceptable
0 Incorrect 0
Trim Trim
56%
Nord Trim Trim Nord
Incorrect

1% 80%
1 3 1 3

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2012: 56 participants
03/2012: Giardia duodenalis, Blastocystis hominis 04/2012: Taenia spp, Clonorchis/Opistorchis spp

100 100
4% 2%
50 Est 50
2%
11%
Est
Correct
Vest
Acceptable
Vest
Correct
Acceptable
0 Incorrect
0 Incorrect

Trim Trim Nord Trim Trim Nord

87%
94%
1 3 1 3

09/2012: Taenia spp, Clonorchis/Opistorchis s pp 10/2012:Hookw orm s, Ascaris lumbricoides, Trichuris trichiura
100 100
11% 4%

50 0% 7% Est 50 Est
Correct
Vest
Correct
Acceptable
Vest
Acceptable
0 Incorrect 0 Incorrect
Trim Trim Nord Trim Trim Nord
93%
85%
1 3 1 3

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2013: 56 participants
03/2013: Iodam oeba, Blastocystis hom inis 04/2013: Giardia duodenalis
100 100
0%
11%
50
5% Est 50 0%
Est
Correct
Correct
Vest
Acceptable
Vest
Acceptable
0 0 Incorrect

Trim Trim Nord

Incorrect
Trim 100%Trim Nord
84%
1 3 1 3

09/2013: Strongyloides stercoralis 10/2013: Ascaris lum bricoides

100 100
0% 9%
50 Est 50 2% 0% Est
Correct
Correct
Vest
Acceptable Vest
Acceptable
0 Incorrect 0
Trim Trim
91%
Nord Trim Trim Nord
Incorrect

98%
1 3 1 3

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Poor results are correlated with:

l parasitic organisms contained in the control

sample to be examined; most difficulties were
observed in :
the malaria diagnosis
the intestinal non-pathogenic protozoa
identification
the rarely found in Romania helminthes
identification
l the number of parasite species in the sample

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The most frequent difficulties occurred in
the participant answers:

l Incorrect identification
l Incorrect name of the parasite
l Confusion between classes: protozoa/
helminthes
l Identification of additional species
l Confusion between stages: trophozoite/ cyst/
egg/ larva/ schizont / gametocyte

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 Measures taken by RoEQALM
for lowering the number of poor
results in the External Quality
Control in Parasitology:
1) Additional explanations sent by mailing
correspondence to the participants with poor
results
for example, in a case where they were mistaken
for species of Strongyloides stercoralis with
Hookworms we have sent:
"The eggs of Hookworms are commonly identified via
coproparasitologic examination; they evolves on the
ground and at this level are developing Hookworms
larvae;
The Strongyloides stercoralis eggs are deposited in the
mucosa of the small intestine and the rhabditoyd larvae
hatches, go into the intestinal lumen and from here to
feces, possible to by found in stool examination

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2) Repeatedly sending parasitic
organisms in control samples

l in September 2011 and March 2013 we

have sent Pseudolimax butschlii/
Iodamoeba; the poor results have
dropped significantly

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 3) Short term training courses in the
field of Parasitology for the participants of
the RoEQALM External Quality Control:

l May 2011 - Quality Management in Parasitology

l March 2012 - Human intestinal Helminthiasis
l October 2013 - Intestinal Protozoa
l March 2014 - The difficulties of the laboratory
specialist in coproparasitological diagnosis

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 Following these directions,
RoEQALM wishes to contribute
to the improvement of
the participants ' performance,
with consecutive decrease of
frequency of poor
results
Thank you!