2022 Competency Assessment, Set B-GC Culture

~This is a competency assessment of testing personnel for CLIA Contract Counties. Every person who performs this test must submit a report. You have only one attempt to submit the report. Once you click submit at the end, your report is final.

~The cultures for this Competency Assessment are sent in lyophilized (freeze-dried) form. Store sealed lyophilized samples at room temp or at 2-4⁰C until reconstitution. The contents of all vials contain enough material for all testing personnel to share.

Supplies
•Sterile distilled water (provided)
•Sterile serological pipettes
•Inoculating loop
•Modified Thayer Martin II media

Procedure
1. Remove metal disk of cap to expose rubber stopper.
2. Carefully, lift edge of rubber stopper to allow for venting. (Contents are under a vacuum.)
3. Remove rubber stopper.
4. With sterile pipette, add 0.5 ml of sterile distilled water to vial.
5. Replace rubber stopper.
6. Mix contents of vial by gentle inversions.
7. Aseptically remove a loopful of suspension and inoculate the MTM II media, streaking for isolation.
8. Incubate according to GC culture procedure.
9. Use your routine testing procedures to screen for N. gonorrhoeae.
~Evaluate the competency samples. Indicate results for those samples in the appropriate boxes below. Some facilities are not required to perform testing past a certain point. In these cases, choose "not applicable" and your report will be adjusted accordingly. If you have any problems with the samples or questions concerning the quiz, contact Angie Bradley at 919-733-7186. Other questions should be referred to your regional technical consultant.

~ Since results will be entered using the internet, each participant must print a copy of the form to sign and keep in house. Sign and date the Attestation Statement below test area.

~All reports must be returned by April 22nd, 2022.
Name: 


A red asterisk (*) indicates required questions.

  1. Please enter the name of your Facility.*


  1. Select the CLIA Contract Area you belong to.*
    Area A (Technical consultant-April Ponder)
    Area B (Technical consultant-Tracey Shives)
    Area C (Technical consultant-Karen Wall)
    Area D (Technical consultant-Linda Cleve)
    Referee Lab


  1. Enter the Date all testing was completed.*


  1. Enter the Lot number and Expiration date of the Modified Thayer Martin II media you are using.*


  1. Select all answers applicable to 22-GC-1. NOTE: You may have only one answer marked or as many as four. Please mark the answers for each portion you performed.*
    Growth
    No Growth
    Oxidase Positive
    Oxidase Negative
    Gram Positive
    Gram Negative
    Cocci
    Bacilli/Rods
    Coccobacilli
    Diplococci


  1. Enter the interpretation for sample 22-GC-1. *
    Presumptive Neisseria gonorrhoeae Found
    Presumptive Neisseria gonorrhoeae Not Found
    Growth, referred for identification


  1. Select all answers applicable to 22-GC-2. NOTE: You may have only one answer marked or as many as four. Please mark the answers for each portion you performed.*
    Growth
    No Growth
    Oxidase Positive
    Oxidase Negative
    Gram Positive
    Gram Negative
    Cocci
    Bacilli/Rods
    Coccobacilli
    Diplococci


  1. Enter the interpretation for sample 22-GC-2. *
    Presumptive Neisseria gonorrhoeae Found
    Presumptive Neisseria gonorrhoeae Not Found
    Growth, referred for identification


  1. Select all answers applicable to 22-GC-3. NOTE: You may have only one answer marked or as many as four. Please mark the answers for each portion you performed.*
    Growth
    No Growth
    Oxidase Positive
    Oxidase Negative
    Gram Positive
    Gram Negative
    Cocci
    Bacilli/Rods
    Coccobacilli
    Diplococci


  1. Enter the interpretation for sample 22-GC-3. *
    Presumptive Neisseria gonorrhoeae Found
    Presumptive Neisseria gonorrhoeae Not Found
    Growth, referred for identification


  1. Select all answers applicable to 22-GC-4. NOTE: You may have only one answer marked or as many as four. Please mark the answers for each portion you performed.*
    Growth
    No Growth
    Oxidase Positive
    Oxidase Negative
    Gram Positive
    Gram Negative
    Cocci
    Bacilli/Rods
    Coccobacilli
    Diplococci


  1. Enter the interpretation for sample 22-GC-4. *
    Presumptive Neisseria gonorrhoeae Found
    Presumptive Neisseria gonorrhoeae Not Found
    Growth, referred for identification


  1. Select all answers applicable to 22-GC-5. NOTE: You may have only one answer marked or as many as four. Please mark the answers for each portion you performed.*
    Growth
    No Growth
    Oxidase Positive
    Oxidase Negative
    Gram Positive
    Gram Negative
    Cocci
    Bacilli/Rods
    Coccobacilli
    Diplococci


  1. Enter the interpretation for sample 22-GC-5. *
    Presumptive Neisseria gonorrhoeae Found
    Presumptive Neisseria gonorrhoeae Not Found
    Growth, referred for identification


  1. Comments or Suggestions?


  1. Please note that you will have ONLY one attempt to submit this report. You must print the form using your browser's print function once your quiz is complete (before submitting!). Once you have completed the quiz, sign the attestation statement and keep a copy of the quiz for your records.

    Attestation Statement: The results submitted on this form reflect my work only. I have not compared results with any other testing personnel. Type your name here, and sign your printed copy. *


  1. I have printed a hard copy of this quiz, either before entering (using the tool box) or after entering (using the web browser's print function.) I will not submit this quiz without having a printed copy in hand! PLEASE REMEMBER TO CLICK ON SUBMIT BELOW ONCE YOU HAVE PRINTED THE QUIZ! You should be directed to a screen that states, “Thank you. Your responses have been submitted.” If you do not receive that message, your results did not go through. Go back through the quiz and make sure you have answered every question with an asterisk. Those questions are mandatory and the quiz will not go through without having something marked for each of those.*
    Yes
    No





Competency Assessment
Regional Laboratory Consultant
NCSLPH
Raleigh, NC