2.1

The National Laboratory should provide and coordinate services, such as a full range of proficiency testing, quality control, and standardization, as required by the provinces/territories.

2.2

The National Laboratory should facilitate the transfer of technology where feasible, including training services.

2.3

A format should be developed for the delivery of information from the provinces and territories to the National Laboratory/LCDC.

2.4

A format should be developed to report to the provinces and territories in a regular, timely manner.

2.5

Participating laboratories should send drug susceptibility information with unique identifiers to a centralized surveillance system (database) at LCDC on a quarterly basis as results become available.

2.6

Cumulative reports should be sent back to provincial programs and participating laboratories within an acceptable time frame. Case reports and laboratory reports should be integrated into one surveillance system

2.7

The national collection of Mycobacterium species (including organisms with atypical identification patterns) should be maintained on a continuous basis. Drug-resistant strains should be collected at either the National Laboratory or the originating provincial/territorial laboratory (i.e. for DNA fingerprinting or banking for future reference) as a resource for the National Tuberculosis Laboratory Network.

2.8

All specimens for mycobacterial culture should be transported promptly and rapidly to an appropriate laboratory as soon as possible, in accordance with the Canadian Tuberculosis Standards.

2.9

Laboratories should ensure that the appropriate methods and procedures are used to promote collection of high quality specimens, optimal processing and rapid reporting.

2.10

Laboratories should achieve average turnaround times (from specimen receipt) not exceeding the following:

a. Smear microscopy
1 working day

b. Detection of growth
14 working days

c. Identification
7 days from isolation

d. Susceptibility testing
30 days (for first-line drugs)

e. Reporting
Within 1 day by telephone to attending physician (or deputy) and public health officials.

2.11

The mechanisms by which reports are received and disseminated should be clearly defined.

2.12

In conjunction with the National Laboratory, provincial/territorial laboratories should develop quality assurance programs for all laboratory methods.

2.13

Amplification methods, if used, should be performed only in addition to microscopy and culture until they are demonstrated to be equivalent or superior in sensitivity and specificity to culture.

2.14

Validation of susceptibility testing by proficiency testing should be continued, to obviate the need for periodic national susceptibility surveys. The National Laboratory should organize and fund this proficiency testing on an ongoing basis.

2.15

All mycobacterial laboratories should satisfy the mandatory biosafety level 3 criteria as described in the Laboratory Biosafety Guidelines (2nd edition, 1996).

2.16

Strain typing should be performed in defined circumstances with close cooperation between epidemiologic investigators and laboratory investigators.

2.17

Strain typing should be performed in facilities with experienced personnel, and these personnel should be involved in the interpretation of the typing results.

2.18

Each jurisdiction should ensure that there are appropriate laboratory services to support the jurisdictional tuberculosis program and that the laboratory services are linked to the clinical tuberculosis program.

2.19

Ongoing surveillance of drug resistance in Canada should be conducted at a national and provincial/ territorial level to detect changes in drug sensitivity patterns promptly.