Small steps, big impact: Effect of mandatory sputum quality assessment prior to sputum culture processing on quality of samples received

Objectives Unnecessary culturing of poor-quality sputum samples may lead to wastage of precious resources. This study highlights changes in the overall quality of sputum samples received in the lab after the implementation of mandatory sputum sample quality assessment by direct microscopy and the subsequent culture processing of only good-quality sputum samples. Material and Methods Quality of sputum was assessed according to widely used standard criteria and only sputum samples with Bartlett’s score of +1 or more were cultured. Assessment of sputum sample quality improvement was done over a six-month study period. Results A total of 1237 sputum samples were collected over six months. In the first month, out of the 163 sputum samples processed, only 41 (24%) were valid by the standard criteria. In the second month, 55% were valid, and in the third month, this percentage further increased to 67%. This percentage further increased in the following months, with over 70% of samples found to be valid in the last two consecutive months. The p-value was found to be significant (p<0.05). Conclusion Rampant antibiotic prescriptions for bacterial isolates from these poor-quality samples further contribute to the emergence of antimicrobial resistance (AMR) besides the wastage of resources. This study emphasizes the urgent need for stricter execution of the rejection policy of poor-quality sputum samples.