EVALUASI QUALITY CONTROL INTERNAL MIKROBIOLOGI

INSTALASI LABORATORIUM KLINIK RSUD DR DARSONO PACITAN

NAMA MEDIA :

Tanggal Pembuatan Media :

Nama Analis :

EXP. DATE media setelah pembuatan :

Jumlah plate yang dibuat :

No LOT Bahan Media :

EXP. DATE Bahan Media :

HASIL TARGET

Warna

Kejernihan

Uji Sterilitas Kuman tidak tumbuh

TEST Kuman Gram POSITIF

(Staphylococcus aureus ATCC 25923)

TEST Kuman Gram NEGATIF

(Escherichia coli ATCC25922)

Tindak Lanjut

Pacitan, …......................................
Penanggung Jawab Mutu

dr Errisa Maisuritadevi Mara, M.Sc, Sp.PK(K)

NIP: 19780520 200903 2 005
 EVALUASI QUALITY CONTROL INTERNAL MIKROBIOLOGI
INSTALASI LABORATORIUM KLINIK RSUD DR DARSONO PACITAN

REAGEN : CAT GRAM

No Lot :
Exipred Date :

TEST Kuman Gram POSITIF TEST Kuman Gram NEGATIF

NO TANGGAL EVALUASI & TINDAK LANJUT TTD PJ Mutu
(S. aureus ATCC 25923) (E.coli ATCC25922)

10

11

12

13

14
15

Pacitan, …......................................
Penanggung Jawab Mutu

dr Errisa Maisuritadevi Mara, M.Sc, Sp.PK(K)

NIP: 19780520 200903 2 005
Preventive maintenance log sheet

JAN FEB MARCH APRIL MAY JUNE JULY AUGUST SEPT OCT NOV DEC
MEDIA, REAGENTS:
1. Cek adanya reagen Expired di dalam
refrigerator dan freezers

2. Cek tanggal membuka kemasan

reagen. for "received" and "opened"
dating.

2. Cek tanggal tanggal kadaluarsa reagen.

Kalibrasi THERMOMETERS:

Kalibrasi PIPET
gram-positive bacteria (Staphylococcus aureus ATCC 25923)

gram negative
bacteria (Escherichia
coli ATCC25922)

Media Failures Log

Media TMS slants
Lot no. In-house preparation 2/13/16
Expiration date 6 months from preparation
Quantity Two racks
Failure Failure to give proper reaction with S. epidermidis, S. aureus, and other coagulase-negative staphs are O

Action taken QC repeated, S. epidermidis failed; memo sent to all technicians and all tubes discarded; new TMS slants
Technologist

Reagent Quality Control

MEDIUM TESTED MFG LOT NUMBER EXP. DATE STERILITY TEST ORGANISMS RESULT

Chocolate II

GC-Lect

Jembec-Neiss.

Campy bld

Campy thio
gulase-negative staphs are OK

es discarded; new TMS slants prepared

ACTION
DATE TECH
TAKEN