Table 3.
Proportion of health workers who performed microscopy checklist steps correctly: first, second, and third visits; and change in score (n = 916)
| Microscopy observation checklist step | Visit number | Percentage point change in score | ||||
|---|---|---|---|---|---|---|
| First | Second | Third | First to second | Second to third | First to third | |
| Number of observations | 293 | 300 | 323 | – | – | – |
| Identifies patient and records patient information in register | 92.2% | 95.3% | 92.0% | +3.1% | −3.3% | −0.2% |
| Wears gloves (count as yes if not available) | 91.8% | 96.7% | 94.1% | +4.9% | −2.6% | +2.3% |
| Cleans slide | 77.5% | 77.7% | 79.3% | +0.2% | +1.6% | +1.8% |
| Labels slide with date and patient’s name and/or number | 79.5% | 83.0% | 80.5% | +3.5% | −2.5% | +1.0% |
| Used finger prick to collect blood: N | 234 | 230 | 260 | – | – | – |
| Cleans finger with alcohol and allows to dry | 90.6% | 92.2% | 89.3% | +1.6% | −2.9% | −1.3% |
| Pricks finger, wipes off first drop of blood, and places subsequent drop on slide w/o touching finger | 66.9% | 70.4% | 75.9% | +3.5% | +5.5% | +9.0% |
| Used venipuncture to collect blood: N | 59 | 70 | 63 | – | – | – |
| Labels ethylenediaminetetraacetic acid collection tube with date and patient’s name and/or number | 65.3% | 85.7% | 78.0% | +20.4% | −7.7% | +12.7% |
| Cleans puncture site with alcohol and allows to dry | 72.6% | 94.0% | 85.7% | +21.4% | −8.3% | +13.1% |
| Assembles sterile needle and syringe or vacutainer | 63.2% | 95.2% | 86.8% | +32.0% | −8.4% | +23.6% |
| Collects and gently mixes venous blood sample successfully | 71.6% | 95.2% | 84.8% | +23.6% | −10.4% | +13.2% |
| Applies blood from only one patient to each thick film slide | 91.1% | 95.7% | 94.7% | +4.6% | −1.0% | +3.6% |
| Spreads thick film into 1–2 cm diameter circle; can read print placed under the slide | 73.7% | 72.0% | 82.7% | −1.7% | +10.7% | +9.0% |
| Air-dries thick film slide before staining | 88.1% | 90.7% | 91.6% | +2.6% | +0.9% | +3.5% |
| Filters stain before use | 62.8% | 78.0% | 76.2% | +15.2% | −1.8% | +13.4% |
| Used Giemsa stain: N | 244 | 237 | 259 | – | – | – |
| Uses standard 10% Giemsa solution | 89.8% | 96.2% | 96.5% | +6.4% | +0.3% | +6.7% |
| Prepares fresh Giemsa staining solution properly or on day of observation | 86.4% | 94.1% | 93.4% | +7.7% | −0.7% | +7.0% |
| pH of the staining solution between 7.2 and 7.4 (count as yes if unable to check) | 91.8% | 96.6% | 87.3% | +4.8% | −9.3% | −4.5% |
| Immerses thick film slide in 10% Giemsa stain for 10–15 minutes | 79.9% | 90.3% | 96.9% | +10.4% | +6.6% | +17.0% |
| Rinses thick film slide carefully with water | 84.8% | 96.2% | 96.9% | +11.4% | +0.7% | +12.1% |
| Used Field stain: N | 49 | 63 | 64 | – | – | – |
| Prepares fresh Field stain A solution (methylene blue) properly or on the day of observation | 72.1% | 51.6% | 70.1% | −20.5% | +18.5% | −2.0% |
| Prepares fresh Field stain B solution (eosin) properly or on the day of observation | 72.1% | 51.6% | 73.1% | −20.5% | +21.5% | +1.0% |
| Immerses slide in stain A for 3 seconds | 77.6% | 59.4% | 61.2% | −18.2% | +1.8% | −16.4% |
| Rinses slide carefully with water after using stain A | 85.1% | 100.0% | 97.0% | +14.9% | −3.0% | +11.9% |
| Immerses slide in stain B for 5 seconds | 79.1% | 57.8% | 64.2% | −21.3% | +6.4% | −14.9% |
| Rinses slide carefully with water after using stain B | 83.6% | 100.0% | 98.5% | +16.4% | −1.5% | +14.9% |
| Drains and air-dries slide (avoiding application of external heat) | 75.4% | 78.3% | 86.1% | +2.9% | +7.8% | +10.7% |
| Segregates and safely disposes off sharps waste in a safety box | 94.2% | 97.0% | 95.4% | +2.8% | −1.6% | +1.2% |
| Disposes off infectious waste in appropriate waste containers | 88.1% | 95.0% | 90.1% | +6.9% | −4.9% | +2.0% |
| Washes off/disinfects liquid waste appropriately | 89.8% | 90.7% | 89.2% | +0.9% | −1.5% | −0.6% |
| Supervisor agrees with staff on slide positivity | 91.8% | 93.7% | 92.3% | +1.9% | −1.4% | +0.5% |
* Checklist steps in bold (“minimum standard” steps) are considered more important and are collectively weighted twice as much as the other steps when calculating scores.