Section 2: Preparation and Checklists

Introduction

Thorough preparation is essential to the success of your workshop. This section describes the activities that you must carry out in advance of the workshop to assure that the workshop achievesexpected outcomes. Information on the basics of training (Section 3) should also be reviewed in advance so that you, as trainer, are adequately prepared to facilitate the workshop.

Participants: Target Audience

This training package is designed for laboratory workers who perform direct smear microscopy. It is important to have an understanding ofyour participant’s baseline knowledge and fears so that these can be adequately addressed during the workshop. It may be necessary to adjust the time allotted for a particular module of instruction or exercise based on identified need.

Suggested number of workshop participants and trainers

For optimum learning experience and management of the workshop, it is recommended that the number of participants should not exceed 4–6 participants per facilitator. The overall number of participants depends upon the laboratory facility for the practical sessions and the participant’s experience in performing AFB microscopy.

The number should be small enough for all participants to be fully engaged, yet large enough for a variety of experiences and viewpoints to be represented. It is equally important to have one trainer for every 4–6 participants to allow participants ready access to trainers during demonstrations and practical exercise.

Participant Notification Letter

Notify participants well in advance of the date, location, and time of workshop. Be sure to include other pertinent information such as payment of perdiems.

Breaks and Lunch

Before the start of the workshop, arrange for morning and afternoon tea or coffee breaks, and plans for having lunch on or off-site.

Facilities and Equipment

For optimal learning experience and ease of managing logistics throughout the workshop, two rooms should be made available:

  • Classroom for lectures, discussions, and classroom exercises
  • Laboratory for hands-on practical exercises.

Classroom

The workshop can be held in any well-lit, distraction-free classroom with 1) tables and chairs, and 2) conveniently located outlets for computer and projection monitor. To facilitate discussion and interaction among participants, tables should be arranged in a semi-circle, or classroom style giving all participants an unobstructed view of the projection monitor. Avoid overcrowding. Bottled water and glasses should be made available on each table.

Classroom equipment

The classroom should have

  • 2 flip charts with easel
  • markers (different colors for flipcharts)
  • DVD player with TV or monitor
  • laptop computer
  • projection monitor (LCD) compatible with computer
  • extension cord
  • wastebasket
  • laser pointer

Classroom supplies

  • marking pens
  • masking tape for posting flip chart
  • note pads
  • pens andpencils
  • calculators

Laboratory

A well ventilated, lit (artificial or natural) laboratory, with running water is required for AFB smear training laboratory. Hand washing facility with soap and water are essential. A work area of 4 square meters per person should be adequate for performing exercises and recording. Additionally, a clean bench top of 75 cm wide and 150 cm long per person is required to perform exercises. Laboratory must have staining sink or rack. Power supply or natural light areafor microscopes is required. Supplies must be labeled and stored in shelves or in other storage area in the laboratory.Demonstration of exercises should be conducted in the center of laboratory or in an area where all participants can have direct and uninterrupted view of the activity. Under no circumstances should laboratory look crowded.

Materials and Supplies

Materials and supplies for demonstration and practical exercises:

Make arrangements well in advance of the workshop to procure or secure the necessary materials, supplies, and reagents. Donot forget to arrange for transport of these items to workshop site. The following is a guide to use for assuring you have an adequate number of supplies on hand during the training workshop. The reagents should be those approved for use in the National Tuberculosis Program.Any unused supplies should be held for future workshops.

Checklist

 / Materials and Supplies / # required per participant
Safety Supplies
Aprons or laboratory coats
Paper towels
Soap or hand sanitizer for hand washing
Bench disinfectant
Spray bottle for disinfectant
Gloves
Container for broken glass
Biohazard waste containers
Waste containers
Biohazard stickers or labels
Safety glasses
Laboratory Supplies and Equipment
Spray bottle and scented oilfor Module 1 exercise
Measuring cylinder (100 ml)
Measuring cylinder (500 or 1000 ml)
Weighing balance ( 0.1g sensitivity)
Flasks of 2liter capacity
Weighing paper
Labelsfor reagent bottles
Diamond pencils
Staining rack
Rack
Microscope with oil immersion objective
Immersion oil
Lens paper or tissue paper
Spirit Lamp for heating
Permanent marker
Containers for newly prepared stain
Specimen Collection
Sputum cups
Request form
Laboratory register
Marker for sputum cups
Reagent Preparation
Weighing balance (0.1 g)
Weigh boats or paper
Basic fuchsin powder
Phenol crystals
Concentrated sulfuric acidof 95% purity
Denatured alcoholof 95% purity
Methylene blue powder
Distilled water
Spirit Lamp
Burning alcohol
Filter funnel
Cotton andgauze
Slide panel
Preparation of AFB Smear
Clean glass slides (frosted end preferred) / 10/participant
Applicator sticks (e.g., bamboo)
Wire loops and sand alcohol flask
Ruler marked with centimeters
Newsprint
Forceps
Miscellaneous Supplies
Spray bottle for Module 1 exercise
Perfume or lavender oil
Staining racks

Smear and Specimen Requirements

The success of your workshop will depend in large part to the quality of specimens and smears used during the practical laboratory sessions.

The practical laboratory session for smear preparation needs to utilize sputum specimens which are similar to those which would be submitted for routine AFB microscopy. However, as this is a training exercise and proficiency of the participants may not have been determined it is important to conduct this practical in a safe manner. Each of the participants should have access to at least three sputum specimens of different consistency to allow the participants develop expertise in preparing smears from all sputum types. Participants will gain maximum benefit from this exercise if they are provided with a purulent, a mucoid and a watery specimen. Specimens should be collected 2 to 3 days prior to the practical to ensure adequate numbers of sputum samples are available. Each pair of participant should be provided with three sputum specimens of different consistency. Options for using sputum specimens are outlined.

Option# / Sputum Type / Description
1 / Previously screened and found not to contain AFB. / As the "key" learning objective for this training is the ability to prepare sputum smears of uniform thickness and size.It is not necessary to use sputum specimens that are known to contain AFB. The practical session can be conducted more safely if the participants are provided with sputum specimens that have been previously screened and found not to contain AFB.
2 / Sputum specimens pre-treated with formalin / Sputum specimens can be pre-treated with 4 drops of formalinper ml of specimen to kill any AFB that may be present in the specimens. This will allow AFB positive sputum specimens to be smeared safely particularly if the participants are inexperienced.
3 / Use known positive sputum specimens / Known positive specimens can be used in the practical sessions if the participants have been previously trained in AFB microscopy and a well ventilated laboratory area is available.
Laboratory Practical Sessions # 1and # 2: Ziehl-Neelsen Reagents Preparation and Quality Control of Ziehl-Neelsen Staining Reagents
Each participant is given 2 unstained smears for quality control of newly prepared stains. QC1 smear should be negative, QC2 smears should be 1+ for AFB
Unstained
Smear / Number ofParticipants / Demo
+ Extra / Total Number of
Smears
QC 1 / 12 / 8 / 20
QC 2 / 12 / 8 / 20
Laboratory Practical Session # 3: Smear Preparation
Each participant prepares 10 smears using previously collected sputum specimens.
Note: Specimens can be shared amongst participants thereby reducing the total number of specimens to one-half.
Sputum
Specimen / QTY / Number ofParticipants / Demo
+ Extra / Total Number of
Specimens
Purulent / 1 / 12 / 2 / 14
Mucoid / 1 / 12 / 2 / 14
Watery / 1 / 12 / 2 / 14
Laboratory Practical Session #4: Smear Staining
Each participant will stain smears from Laboratory Practical Session # 3 and a set of fivesmearsfrom the panel provided
Unstained
Smear # / Grade / Number ofParticipants / Demo
+ Extra / Total Number of
Smears
P-1 / No AFB / 12 / 8 / 20
P-2 / 1+ / 12 / 8 / 20
P-3 / 2+ / 12 / 8 / 20
P-4 / 3+ / 12 / 8 / 20
P-5 / < 9 AFB / 12 / 8 / 20
Laboratory Practical Session #5: Viewing of Prepared and Stained Smears from Laboratory Practical Session # 4
Participants' Prepared and Stained smearsfrom Practical Session # 4 will beused during the Practical Session #5. Participants are to review each smear in terms of
  1. Thickness of smear
  2. Size of smear
  3. Uniformity of staining
  4. Appearance and characteristics of AFB
Results are discussed after participant interpretation.
Laboratory Practical Session # 6: Reading and reporting of Stained Panel Slides from Laboratory Practical Session # 4
Panel Smears Stained in Practical Session # 4 will beused during the Practical Session #6. Participants are to review each smear in terms of
  1. Identify AFB
  2. Counting of AFB
  3. Recording of AFB
  4. Reporting of AFB
Results are discussed after participant interpretation.
Final Practical Examination
A total of 10 blindedstained smears are required for each participant.
Participants are asked to evaluate each smear in terms of
  1. Reading and interpretation of smear
  2. Smear quality
For the Final Practical Examination, prepare a panel containing 10 stained smears. For ease of preparation, 4–5 sputum specimens of different grades are required. Slides labeled F–6 to F–10are a repeat of the first five slides.
Example of Final Practical Examination
Each participant reads and interprets using 10 stained smears.
Unstained
Smear # / Grade / # participants / Extra
F-1 / No AFB / 12 / 8
F-2 / 1+ / 12 / 8
F-3 / 2+ or 3+ / 12 / 8
F-4 / < 9 AFB / 12 / 8
F-5 / < 9 AFB / 12 / 8
F-6 / No AFB / 12 / 8
F-7 / 1+ / 12 / 8
F-8 / 2+ or 3+ / 12 / 8
F-9 / < 9 AFB / 12 / 8
F-10 / < 9 AFB / 12 / 8
Summary of Smears Required for Final Practical Examination
Grade of Smear / # Slides
No AFB Seem / 40
1-9/AFB/100 fields (Scanty) / 80
1+ / 40
2+ or 3+ / 40

Validation of Panels

All panelsamples used during the hands-on sessions MUST be validated prior to the workshop to assure that expected results are obtained on each smear.

Please refer toExternal Quality Assessment for AFB Microscopy for details on preparing panel of slides of known contents.

Print Materials Needed During Training

As a workshop facilitator or trainer, it is your responsibility to make sure the appropriate materials are available at the start of the workshop for each participant

  • Pre-courseand post-course tests
  • Forms to record results of practical examinations
  • Daily evaluation questionnaire
  • Post workshop evaluation
  • Final examination form
  • Participant manual
  • Name tents
  • Name badges.

Training Certificates

At the end of the workshop, each participant who has metthe criteria for successful completion will receive a Certificate of Training. Prior to the workshop, you will need to

  • Identify appropriate individuals to who will sign the certificate
  • Verify spelling of names
  • Print certificates.

Training schedule

The theoretical and practical sessions of this workshop are designed to be delivered in 4–5 days.

A template is provided for finalizing your training schedule. Before conducting the workshop, finalize your schedule for the week by completing as follows:

  • Write in planned times for breaks and lunch.
  • Add any additional presentations or activities not included in the template.
  • Fill in planned times for the activities in the Workshop Timing column. For example, if the workshop is scheduled to begin at 8:30 a.m., write 8:30–9:30 a.m. for the Welcoming remarks and introductions.

Duration of Workshop

The duration of any given workshop may depend on several factors:

  • Availability of facility
  • Refresher training
  • Focused training on specific modules
  • Responsibilities of target audience
  • Availability of trainers

Training Schedule Template

MONDAY - DAY 1

Start Time / - / End Time / Total Time / Description / Module # / Faculty
Hours / Min.
______ / - / ______ / 0 / 30 / Registration / ______
______ / - / ______ / 1 / 00 / Welcome Remarks & Introductions / ______
______ / - / ______ / 0 / 10 / Workshop Goals, Objectives
Ground Rules, / ______
______ / - / ______ / 0 / 30 / Pre-test / ______
______ / - / ______ / 1 / 20 / Overview: Tuberculosis, The Global Emergency / 1 / ______
______ / - / ______ / 1 / 10 / Safety Precautions for TuberculosisMicroscopy / 2 / ______
______ / - / ______ / 1 / 35 / Collection and Transport of Tuberculosis Specimens / 3 / ______
______ / - / ______ / 0 / 10 / Daily Evaluation / ______
Total Time / 6 / 25

TUESDAY - DAY 2

Start Time / - / End Time / Total Time / Description / Module # / Faculty
Hours / Min.
______ / - / ______ / 2 / 35 / Managing Supplies for Sputum Smear Microscopy / 4 / ______
______ / - / ______ / 4 / 15 / Preparation of Ziehl-Neelsen Reagents / 5 / ______
______ / - / ______ / 0 / 10 / Daily Evaluation / ______
Total Time / 7 / 00

WEDNESDAY - DAY 3

Start Time / - / End Time / Total Time / Description / Module # / Faculty
Hours / Min.
______ / - / ______ / 5 / 30 / Smear Preparation and Staining / 6 / ______
______ / - / ______ / 0 / 10 / Daily Evaluation / ______
Total Time / 5 / 40

THURSDAY - DAY 4

Start Time / - / End Time / Total Time / Description / Module # / Faculty
Hours / Min.
______ / - / ______ / 3 / 00 / Microscopy / 7 / ______
______ / - / ______ / 3 / 35 / Recording and Reporting of Smears / 8 / ______
______ / - / ______ / 0 / 10 / Daily Evaluation / ______
Total Time / 6 / 45

FRIDAY - DAY 5

Start Time / - / End Time / Total Time / Description / Module # / Faculty
Hours / Min.
______ / - / ______ / 1 / 35 / Microscope Maintenance / 9 / ______
______ / - / ______ / 1 / 15 / Quality Assurance of Sputum Microscopy / 10 / ______
______ / - / ______ / 2 / 00 / Final Examination / ______
______ / _ / ______ / 0 / 30 / Post Test / ______
______ / ______ / 0 / 15 / Overall Workshop Evaluation / ______
______ / - / ______ / 0 / 30 / Closing Ceremony
Presentation of Certificates / ______
Total Time / 6 / 05

Are You Ready? Checklist

This checklist summarizes all the preparatory activities that must be completed before conducting an Acid Fast Direct Smear Microscopy workshop. If you are not responsible for carrying out a workshop activity, make sure someone else has been assigned responsibility.

ACTIVITY CHECKLIST:

PREPARATION FOR ACID FAST DIRECTSMEAR MICROSCOPY WORKSHOP

BEFORE theWORKSHOP
When complete / Activity: Six to Eight Weeks before Workshop
Adapt course content based on results of needs assessment.
Verify or develop training budget.
Identify target audience.
Agree on maximum number of participants.
Finalize names of trainers.
Finalize names of guest speakers for opening and closing ceremonies.
Send letter of invitation to co-trainers.
Send letter of invitation to speakers for opening and closing ceremonies.
Identify who will be responsible for each task
Develop a list of tasks necessary to present course, and negotiate with co-trainers to decide who will complete each task.
Meet with co-trainers to coordinate roles and responsibilities(announce date, site and agenda in advance of co-trainer meeting).
Develop and review the participant manual and other training material.
Determine training supplies and materials needed.
Develop a detailed agenda setting time-frame for course and speakers.
Set DATE and LOCATION for workshop. Verify that the date does not coincide with major events or religious holidays. Ensure that invited speakers agree on date and place.
When complete / Activity: Four Weeks before Workshop
Develop workshop announcement and registration materials.
Mail workshop announcement and registration materials to target audience. Announcement should include: “who should attend”, course title, course content and agenda, course objectives, date and location, instructions for registering, lodging and travel information (if necessary) and name of contact person.
Confirm arrangements for travel and lodging for co-trainers and guest speakers, if necessary.
Agree on arrangements such as per diem for co-trainers and guest speakers.
Conduct site visit to laboratory that will host workshop.
Send letter of confirmation to co-trainers.
Send letter of confirmation to guest speakers for opening and closing ceremony.
Send letter of confirmation to hosts of field visit sites.
Develop course flyer and registration materials.
Set agenda for Opening Ceremony and Course Introduction.
Set agenda for Closing Session.
Order or assemble training supplies including pencils, pens, reagents, and equipment.
Provide deadlines for co-trainers for submitting audiovisual materials, audiovisual equipment needs and handouts for printing.
When complete / Activity: Three Weeks before Workshop
Reserve audiovisual equipment (e.g.,check working condition, extra light bulbs, and electrical outlet requirements).
Obtain flip charts, pointers, felt tip markers and other training materials as needed.
Confirm training venue location.
Check venue for adequate light, space, seating arrangement, temperature control, and handicap access.
Check laboratory facility for appropriate space for laboratory supplies and equipment.
Develop or adapt Pre and Post-test forms.
Develop or adapt Final examination form.
Develop or adapt Workshop Evaluation form.
When complete / Activity: Two Weeks before Workshop
Print and assemble participant manual.
Print handouts, Pre-and Post-test forms, Evaluation forms, final examination formand agenda.
Check on progress of participant registration.
Assemble audiovisual materials (e.g., power point files, videos, overheads).
When complete / Activity: One Weeks before Workshop
Make name tags for participants, co-trainers and speakers.
Develop sign in sheet for participants.
Develop course completion form or course certificate.
Confirm audiovisual reservations.
Prepare supplies and training materials for transport to training site.
Review and rehearse training curriculum.
Prepare welcome and directional signs for the training site.
DURING THE WORKSHOP
Day 1 - One hour before start time:
  • Place welcome and directional signs at the facility.
  • Set up table to register and sign in participants and distribute training manual, name tags, training handouts and course agenda
  • Check set up of room, check audiovisual equipment, adjust temperature, check supplies e.g. markers and flip charts.

Day 1
  • Conduct Pre-test
  • Conduct training according to agenda

Day 2 thru last day, one hour prior to schedule start time:
  • check set up of room
  • check audiovisual equipment
  • adjust temperature
  • check that all necessary supplies are in place

Last day
  • Conduct final examination, post-test, and evaluation.

IMMEDIATELY AFTER THE WORKSHOP
Debrief with co-trainers.
Send thank you letters to speakers and other "key" officials.
Assemble and evaluate pre-and post-test and final examination data.
Analyze workshop evaluation data.
Prepare report of training.
1-3 MONTHS AFTER THE WORKSHOP
  • Follow up with participants to verify if they were able to apply knowledge and skills obtained during the workshop.
  • Identify additional technical assistance or further training needed.

Section 2: Preparation and ChecklistsPage 1 of 15AFB Trainer’s Guide