My journey in transfusion medicine began as a clinical pathology medical technologist, a role that was both challenging and initially intimidating. I was not sure how I could contribute meaningfully to this vital field. However, this uncertainty sparked a desire to push my intellectual boundaries and delve deeper to identify areas for improvement and develop solutions.

This desire coincided with a critical gap in our laboratory – the lack of a robust external quality control programme for transfusion medicine microbiology. This absence was especially concerning as it meant there was no standardised system to assess the accuracy and reliability of our microbiological testing for blood products. Identifying this gap fuelled my passion to pursue research in External Quality Control (EQC). Furthermore, upon discovering the lack of certified EQC materials using the correct matrix for transfusion microbiology, I realised this was a significant opportunity to contribute. It was a chance to apply my technical expertise and make a tangible impact on patient safety.

A key challenge involved procuring bacterial strains from the Paul-Ehrlich-Institute in Germany. Unfortunately, the global pandemic disrupted international shipping, causing delays in receiving these essential research materials. This necessitated extending the project timeline by a year.

While designing the programme, I encountered a challenge specific to the African context. Unlike some regions where transfusion services perform their own microbiology testing, many African countries subcontract these tests to pathology laboratories as they do not have the resources to perform these tests. This meant these specific countries could not participate in the study.

Using an External Quality Assessment (EQA) that is stable and matrix-equivalent not only contributes to producing accurate and precise results but also significantly enhances the confidence and technical competency of testing laboratories. The EQA serves as a crucial support system for accreditation, facilitating the identification of laboratories of excellence by public health authorities and instilling confidence in the results they produce.

To ensure the reliability and stability of the PT matrix, my study employed a prospective cross-sectional approach. Participating laboratories received matrix-equivalent samples, tested these samples, and sent their results back for evaluation. The qualitative results were captured in an Excel spreadsheet and converted to quantitative forms for analysis. The quantitative data were then analysed using the Statistical Package for the Social Sciences (SPSS) version 28, where Cohen's Kappa (κ) was measured to assess inter-laboratory agreement. This combination of methodologies and statistical analyses ensured a robust evaluation of the PT matrix's reliability and stability.

The use of matrix-equivalent EQA should be adopted globally by all laboratories testing transfusion microbiology-related samples. Currently, many African countries subcontract microbiology testing, including bacterial screening, to pathology laboratories that are already enrolled in some form of EQA. However, these existing EQAs often do not cover transfusion medicine sample types. Future research should focus on developing and validating matrix-equivalent EQA specifically for transfusion microbiology to ensure comprehensive quality assurance.