Competency Assessment, Set B-Urine Colony Count

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

~The cultures for this Competency Assessment Series are sent in lyophilized (freeze-dried) form. Store the sealed lyophilized sample at room temperature or at 2-4 degrees Celcius until reconstitution. The sample should be cultured immediately after reconstitution and mixing.

Supplies
•Sterile distilled water (provided)
•Sterile serological pipettes
•Calibrated loops and appropriate medium or urine kit designed for semiquantitative culture

Procedure
1. Remove the metal disk of the cap to expose the rubber stopper.
2. Carefully, lift the edge of the rubber stopper to allow for venting. (contents are under a vacuum.)
3. Remove the rubber stopper.
4. With sterile pipette, add 5 ml of sterile distilled water to the vial.
5. Replace the rubber stopper.
6. Mix the contents of the vial by gentle inversions.
7. Use your routine urine culture procedures:
i. For inoculation of plated medium with calibrated loop, aseptically remove a loopful to each medium.
ii.For inoculation of urine kit, aseptically dip or pour the sample.
8. Incubate according to urine culture procedure.
~Evaluate the competency samples. Indicate results for those samples below. If you have any problems with your samples or questions concerning the quiz, contact Diana Scarborough at 919-733-7186. Other questions or comments 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 reporting area.

~All reports must be returned by May 1.
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 Hill)
    Area B (Technical consultant-Tracey Shives)
    Area C (Technical consultant-Karen Wall)
    Area D (Technical consultant-Sherri Felts)
    Referee Lab


  1. Enter the Date all testing was completed.*


  1. Enter the Lot number and expiration date of the media you are using. If using Uricult, enter 'not applicable.'


  1. Enter the Lot number and expiration date of the Uricult you are using. If using calibrated loops, enter 'not applicable.'


  1. Select all answers applicable to 13-UC-1. NOTE: You may have only one answer marked or as many as three. Only mark the answers for each portion you performed.*
    Growth
    Growth, Send to Reference Lab
    No Growth
    Pure Culture
    Mixed Culture
    <1000 cfu/ml
    1000 – 10,000 cfu/ml
    10,001 – 50,000 cfu/ml
    50,001 – 100,000 cfu/ml
    >100,000 cfu/ml


  1. Select all answers applicable to 13-UC-2. NOTE: You may have only one answer marked or as many as three. Only mark the answers for each portion you performed.*
    Growth
    Growth, Send to Reference Lab
    No Growth
    Pure Culture
    Mixed Culture
    <1000 cfu/ml
    1000 – 10,000 cfu/ml
    10,001 – 50,000 cfu/ml
    50,001 – 100,000 cfu/ml
    >100,000 cfu/ml


  1. Select all answers applicable to 13-UC-3. NOTE: You may have only one answer marked or as many as three. Only mark the answers for each portion you performed.*
    Growth
    Growth, Send to Reference Lab
    No Growth
    Pure Culture
    Mixed Culture
    <1000 cfu/ml
    1000 – 10,000 cfu/ml
    10,001 – 50,000 cfu/ml
    50,001 – 100,000 cfu/ml
    >100,000 cfu/ml


  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