Welcome to the summer edition of the UK NEQAS for Microbiology newsletter.
So far, 2022 has been a very busy year, the Carbapenemase-Producing Organisms scheme was launched, we have held a virtual workshop for participants, delivered an EQA on RSV in collaboration with the WHO and included new SARS-CoV-2 variants in two EQA schemes.
Did you know that in addition to providing clinical specimens for examination, UK NEQAS for Microbiology also offers a scheme to support end-to-end EQA. This is known as PrepQ: Pre- and Post- Analytical Quality Monitoring Service.
PrepQ is a web based monitoring service which extends the scope of quality surveillance beyond the analytical phase and measures adverse incidents in the pre- and post-analytical phases.
Eleven quality indicators (8 pre-analytical and 3 post-analytical) are monitored; all chosen for clinical relevance and practicality and is applicable to all disciplines. For more information on this scheme please follow the link Pre and Post-Analytical Quality Monitoring Service (PrepQ) – UK NEQAS
As restrictions have lifted in the UK and more events are being held face to face, the plan is to go ahead and host our UK NEQAS for Microbiology scientific day as a face to face event on the 25th November 2022 in London. We hope to see as many of you there as possible. Further information is detailed within the newsletter.
Best wishes from all of us in UK NEQAS for Microbiology.
Since 1969 the United Kingdom National External Quality Assessment Service (UK NEQAS) consortium have provided External Quality Assessment (EQA) to clinical laboratories. In May 1971, the first microbiology specific distribution was dispatched from the Public Health Laboratory, Sunderland, by Dr.Crone with analysis carried out by the Epidemiological Research Laboratory, Colindale. Since the launch of this first scheme, UK NEQAS for Microbiology now provides over 50 schemes covering bacteriology, mycology, virology, and parasitology disciplines. Programmes offered range from qualitative, quantitative and interpretive analysis and are designed to meet accreditation requirements for clinical laboratories and point of care providers (POCT), with an emphasis on quality improvement and being educational.
The first distribution of EQA specimens from UK NEQAS for Microbiology were dispatched on 1 May 1971. The panel comprised of three specimens, E. coli 0111, a dual pathogen of S. sonnei and Salmonella Typhimurium and a Salmonella Typhimurium. A total of 67 participants reported results for this first distribution. A report for the same EQA scheme 50 years later maintains the same number of specimens, however, participant numbers have now increased to 600.
For those who were unable to attend the webinars celebrating our 50th birthday, a full recording of a presentation delivered by the Scheme Organiser for Bacteriology & Mycology Dr Jennifer Henderson, can be found by clicking on the below link and selecting ‘50th year celebration of UK NEQAS for Microbiology’:
The Institute of Biomedical Science (IBMS) is the leading professional body in the field of biomedical science in the UK. In March this year, our Research and Development Healthcare Scientist Practitioners, Heather Crowton and Mohammed Islam, presented posters at the IBMS Congress held in Birmingham.
Heather presented a poster on our newly launched SARS-CoV-2 Point of Care EQA scheme, discussing participant demographics, performance and methods commonly employed over the pilot and first four live distributions. Following a successful presentation at the IBMS, the SARS-CoV-2 Point of Care poster has also been published as an article in the May edition of Pathology in Practice.
Mohammed presented a poster on the development of our new Carbapenemase-Producing Organisms (CPO) scheme, reporting the successful implementation of liquid Amies swabs as a sample type, in addition to discussing participant performance and methods commonly employed in the pilot distributions.
Both of these posters are available for viewing on our website and on the IBMS website.
Well done to both Heather and Mohammed at their first IBMS Congress!
After a couple of years away, we are glad to say that the UK NEQAS for Microbiology Scientific Meeting is back.
The 2022 UK NEQAS Microbiology Division Scientific Meeting will take place on Friday 25 November 2022 at the Holiday Inn, Bloomsbury, Central London.
The title of this year’s meeting is ‘Treatment and Management of Infection Matters to Us!’ The meeting will provide participants with the opportunity of hearing expert speakers as well as being able to meet with members of the UK NEQAS for Microbiology Division and our Steering Group as well as other participants of our schemes.
A link to register for this meeting will be sent out in the next few days. In the meantime if you would like any further information please contact Joanna at firstname.lastname@example.org
UKAS SU1 assessment to ISO/IEC 17043: 2010 took place 21-25th February 2022.
All improvement actions raised requiring evidence to be submitted to UKAS have now been satisfactorily cleared in round one and accreditation maintained.
This scheme has been created by merging the Hepatitis E serology EQA and the molecular detection of Hepatitis E virus EQA.
Both these schemes were launched in 2018 when the number of HEV cases started rising in the UK and worldwide.
The aim of the HEV EQA is for laboratories to determine the infectious status of HEV. Participants are required to determine the presence or absence of IgM and IgG to Hepatitis E and that of Hepatitis E virus RNA using molecular assays. Participants are also required to qualitatively determine the presence of HEV RNA in each specimen.
Scoring is based on the detection of HEV IgM, HEV IgG and on the qualitative determination of presence (detected) or absence (not detected) of HEV RNA in each specimen separately.
The scoring algorithms are described below for HEV IgM, IgG and HEV RNA (Table 1).
|HEV IgM positive
|HEV IgM positive
|HEV IgM equivocal
|HEV IgM equivocal
|HEV IgM negative
|HEV IgM negative
|HEV IgG positive
|HEV IgG positive
|HEV IgG equivocal
|HEV IgG equivocal
|HEV IgG negative
|HEV IgG negative
|Hepatitis E RNA positive
|HEV RNA positive
|Hepatitis E RNA negative
|HEV RNA negative
Table 1: Scoring Algorithms for HEV detection EQA scheme
Due to changes in the scheme design it will be submitted for ISO 17043:2010 accreditation in August 2022, after the first distribution has taken place and reports produced.
One hundred incident review forms (IRFs) were received between1st April 2021 to 31st March 2022. Of the 100 IRFs received, 11% (n=11) were for non-returns of results. The remaining 89 % (n=89) were submitted by participants who failed to score a maximum of 2 for each of the results that they submitted.
Figure 1 provides a breakdown of IRFs submitted by scheme.
IRFs are taken into considerations for performance monitoring and should be ideally completed online within 30 days of the report publication date. IRFs are evidence that the participating laboratories have identified the root cause and taken remedial actions. IRFs are available on the following link: Incident Review Form (ukneqasmicro.org.uk)
For a few years now, the World Health Organization (WHO) Expert Committee on Biological Standardization have established WHO international standards for EBV and CMV for nucleic acid amplification techniques as it is very difficult to compare viral load measurements between different laboratories and to develop uniform treatment strategies, given the heterogeneity of these NAT-based assays. Reporting EBV and CMV DNA quantification in international unit (IU) is now recommended. We would therefore like to align the CMV (MG) and EBV (EG) DNA quantification schemes to capture and display results in IU/mL or log IU/mL. Presently, the results are captured in copies/mL and log copies/mL. Participants who are currently reporting in copies/mL and log copies/mL are advised to find out the conversion factors in order to convert their results to IU/mL or log IU/mL. If you have any questions or queries, please feel free to contact us via email at email@example.com.
UK NEQAS for Microbiology currently offer two EQA schemes for SARS-CoV-2, geared towards Point of care (POCT) providers and also for diagnostic laboratories testing for SARS-CoV-2.
The SARS-CoV-2 Point of care EQA, is dispatched in a liquid format in viral transport medium (VTM). There are six distributions per year and each distribution consists of four specimens and participants are able to return results for two different methods. Participants include pharmacies, GP surgeries, COVID-19 test providers, hospitals and private clinics. In the latest distribution (5191) the overall performance was excellent with 98.0% of participants returning the intended results for their first method and 97.2% of participants returning the intended results for their second method across all specimens.
The Molecular detection of SARS-CoV-2 is more popular amongst clinical laboratories in the UK and worldwide.
This scheme is dispatched every month and contains 2 freeze dried specimens. The added bonus in this scheme is that the latest variant is included at no extra cost to the participant!
At the moment, this scheme is subscribed by participants from over 40 countries worldwide (Figure 2).
Armenia (AM), Austria (AT), Bahrain (Kingdom of) (BH), Belgium (BE), Brazil (BR),Cayman Islands (KY), Colombia (CO), Croatia (HR), Cyprus (CY), Czech Republic (CZ),Germany (DE), Egypt (EG), Ethiopia (ET), Falkland Islands (FK), Finland (FI), France (FR),Gibraltar (GI), Greece (GR), Ireland (IE), India (IN), Italy (IT), Israel (IL), Kuwait (KW) , North Macedonia (MK), Malawi (MW), Mali (ML), Morocco (MA), Oman (OM), Pakistan (PK), Philippines (PH), Poland (PL),Portugal (PT), Sierra Leone (SL), Slovenia (SI), South Africa (ZA), Spain (ES), Sweden (SE),Switzerland (CH), Tanzania (TZ), Trinidad and Tobago (TT), Turkey (TR), United Arab Emirates (AE), UK and Zimbabwe (ZW).
Participants benefit from a detailed report that captures information on different gene targets (Table 2) and Ct values submitted by all participants in addition to information on various mutations and genotyping results analysed in the reports.
The reports also provide added value information on the latest updates on the epidemiology of SARS-CoV-2 worldwide.
As an EQA provider, UK NEQAS for Microbiology has an obligation to report any assay/ platform that has performance issues to the MHRA through the Yellow card system (https://yellowcard.mhra.gov.uk/), in addition to informing the manufacturer to enable their own investigation.
Participants whose assays/ platforms may be affected are encouraged to contact the manufacturers so that any investigation on their part can be expedited.
There has been a recent update in scoring to reflect changes in the EUCAST category of Susceptible, increased exposure. This was communicated via email to all participants in the following schemes: genital pathogens, community medicine and the antimicrobial susceptibility scheme. This change took affect from April 2022.
The updated scoring policy can be found by following the below link:
Changes to scoring are discussed with the antimicrobial susceptibility testing advisory group, in addition to the Microbiology steering committee and the National Quality Assurance Advisory Panel for Medical Microbiology. These groups are composed of external experts in field who offer impartial advice and information.
Following the successful delivery of the pilot, we are pleased to announce the launch of the CPO scheme from April 2022.
UK NEQAS for Microbiology delivered a workshop in March of this year which detailed the processes involved in the implementation of the new scheme. The presentation is available for viewing on our YouTube channel or by clicking the below link and select ‘Research & Development’:
To register for the CPO scheme and for any queries, please email firstname.lastname@example.org
A mini questionnaire was added to the web reply form in the most recent distribution (June 2022). Participant responses will allow us to collate information on methods in current use to identify filamentous fungi by our participating laboratories.
We endeavour to illustrate the methods in future reports.
UK Health Security Agency (UKHSA) was approached by the World Health Organization Eastern Mediterranean Regional Office (WHO EMRO) to provide expert advice to Unité des Laboratoires de Biologie Médicale (ULBM) and the three associated laboratories (La Rabta University Hospital, Charles Nicolle University Hospital and the Centre National de Greffe de la Moelle Osseuse), that prepare the NEQAS (National External Quality Assessment Scheme) specimens. The support was intended to allow all parties to improve in areas where gaps were identified in order to deliver a more robust EQA. UKHSA jointly with UK NEQAS for Microbiology delivered training between November 2021 and May 2022.
The ULBM is a national coordinating centre in Tunisia that provides an annual NEQAS in bacteriology to over 500 participating clinical laboratories. The scheme was established in 1992.
The programme of support was divided into two sections. The first was delivery of a virtual training workshop where the clauses of ISO/IEC 17043:2010 were discussed. The aim was to help the parties identify their key compliance gaps against the standard and then establish an improvement programme.
The second was an on-site training in Tūnis. The aim of this event was to discuss priority areas of improvement, based on an overall strategy, observe laboratory processes, check documentation, and make recommendations that would allow all parties to improve in the areas identified. ISO/IEC 17043:2010 was used as a guide for EQA requirements. UK NEQAS for Microbiology provided examples of how it currently fulfils the standard. In addition support was provided to ULBM to improve its preparation of reports and minimise turnaround time.
The UK NEQAS Parasitology Teaching Programme was invited to the XLIX Congresso Nazionale AMCLI (Italian Association of Clinical Microbiology) which took place in Rimini, Italy from 26/2/2022 to 01/03/2022.
The topic “UK NEQAS Parasitology Teaching and Learning” highlighted the challenges parasite microscopy is currently facing and the approach UK NEQAS Parasitology has taken to address these challenges through the inception of the parasitology teaching programme.
The Congress expressed great admiration and appreciation for the work of UK NEQAS Parasitology, with greater than half the audience having from departments registered with UK NEQAS for Microbiology. The presentation has since received some positive feedback from the Conference Organisers. Dr Annibale Raglio, a member of the Organising team, wrote:
“Dear Prof Chiodini and Dott Boadi,
I can only say thank you again for your support. The lecture was really useful and underlined the problems of the diagnosis of parasites today.
Thank you again
One aspect that was clear from the Conference was that the challenges parasite microscopy faces in the UK are the same as those faced by our Italian colleagues: Experts taking retirement, new entrants to the speciality facing shortages of discipline-specific training opportunities, the rise of and dependence on Nucleic Acid Amplification Tests (NAATs).
The UK NEQAS Parasitology teaching programme offers training to support improvements in parasite microscopy for our participants.
Enrolment is through UK NEQAS Microbiology registration process. For more information on registering and costs please email email@example.com and visit the teaching website at http://parasitologyprogramme.org.uk/index.php.
Participants registered for the UK NEQAS for Microbiology Interpretive Comments scheme over the recent months, have unfortunately experienced delays in obtaining final reports for case studies.
The decision was made, to temporarily suspend the scheme, predominantly due to the absence of a dedicated Scheme Organiser.
I am pleased to inform you all, that we have now appointed to this role.
The outstanding reports are being finalised and will be uploaded once complete.
The scheme is scheduled to resume from 1st August 2022.
A communication will be sent to participants shortly, to register for the year 2022-23.
I would like to take this opportunity to thank you all for your patience and support during this time.
Dr Sanjiv Rughooputh, Virology Scheme Organiser
I started my Level 3 Apprenticeship in Applied Science (Medical) in January 2020 with UK NEQAS for Microbiology. I undertook learning in my role as a Healthcare Scientist Support worker, part of the Production team for four days a week, with one day a week on study leave, where I would attend my lectures and undertake writing assignments and papers. The majority of my learning was online with CSR group scientific, an online college that specialise in scientific apprenticeships.
I had the opportunity to carry out some practical sessions in addition to my online learning, where I could practice my knowledge and experience. In these practical sessions, I learnt how to plan and carry out a scientific investigation, as well as write up a report and academic-style paper on the topic. One of the practical was based on antimicrobial susceptibility testing, which was of particular interest to me. This in turn made me understand how the UK NEQAS for Microbiology susceptibility testing EQA scheme works and how important it is when combatting antibiotic resistant bacteria.
During the two years of the COVID-19 pandemic, I have witnessed how UK NEQAS for Microbiology responds to new and emerging diseases by developing new EQA schemes in a relatively short time span. It made me proud to be a part of this, knowing I have assisted and continue to assist in helping produce these schemes for our participants, both in the UK and internationally.
In January 2022, I was assessed in the laboratory as part of my endpoint assessment; it was here where I could demonstrate the knowledge and skills which I had learnt over the past two years. With all my hard work and commitment, I achieved two distinctions in my endpoint assessment, which I was thrilled about. I now continue to work in the Production team for the time being, and I look forward to continuing my career in science and taking the next steps to become a biomedical scientist in the future, knowing that what I have learnt and achieved will help me to fulfil this goal.
I joined UK NEQAS for Microbiology as a Healthcare Scientist Practitioner in December 2021 and have not looked back since.
I have really enjoyed the opportunities that I’ve been presented with in terms of carrying out technical diagnostic work on numerous bacteria, fungi and yeast species. This is something I hadn’t had much experience with previously due to the remit of my previous role, where I worked as a Medical Laboratory Assistant.
The first thing I noticed when I joined UK NEQAS for Microbiology was how knowledgeable all the staff are. Initially this left me with some feelings of anxiety/symptoms of the ‘imposter syndrome’, but the team quickly welcomed me as one of their own and have reassured me that I am picking things quickly.
I have already become competent in several techniques, am working on my HCPC registration portfolio and aiming to expand my theoretical knowledge on different organisms. This positive atmosphere has made UK NEQAS for Microbiology such a fun environment to work in and develop as a budding scientist.
My name is Aishwarya Arunagirinathan, Healthcare Scientist Practitioner in UK NEQAS for Microbiology.
I am from Tamil Nadu, India. I moved to the UK in September 2020 to do a Masters in Medical Microbiology at the London School of Hygiene and Tropical Medicine. It was a challenging year due to the COVID-19 pandemic and for someone from abroad I had a difficult time adapting to the UK education system. As I was undertaking my Masters, I got the opportunity to work in the COVID-19 testing service at the UK Health Security Agency (UKHSA).
Working in the COVID-19 testing service was rewarding, as I was able to help the community during a pandemic, all whilst developing my knowledge on novel techniques. A few months into the role in October 2021, I was given the wonderful opportunity to work with UK NEQAS for Microbiology in Bacteriology.
I am grateful to be part of this small but highly experienced and efficient team. I feel included and my voice heard. I like how there is a system in place and every process is controlled, with a procedure to follow. I thoroughly enjoy working here as I am learning lots each day, with particular thanks to Jennifer Henderson and Shila Seaton for supporting my development. For someone like me who is coming from elsewhere it is a dream to be able to work in an organisation full of laboratories and experienced scientists. I feel like a child inside a candy store. Thank you for the opportunity, I will be forever grateful.
UK NEQAS for Microbiology delivered a virtual workshop in March 2022. The workshop was suitable for all levels and abilities of scientific staff and was aimed at addressing frequently asked questions. Recordings of each can be found by clicking on the below links:
Chayanika Biswas – Virology and Molecular Scheme Manager (maternity cover) (04/04/2022)
Salvador Castillo – HCS Laboratory Support Worker (28/05/2022)
Sofiri Daminabo – Healthcare Scientist Team Manager (04/01/2022)
Lewis Hull – Healthcare Scientist Practitioner (13/12/2021)
Liya Jain – Placement Student (14/09/2021)
Radia Larkem – Healthcare Scientist Specialist (24/01/2022)
Aishwarya Arunagirinathan – Healthcare Scientist Practitioner (18/10/2021)
Viraj Acharya – Operations Administrator (01/12/2021)
Jake de los Reyes – Laboratory Support Worker (03/12/2021)
Julia Baguley – HCS Laboratory Support Worker (Bank staff) (08/03/2022)