UK microbiology laboratories that do not use Standards for Microbiological Investigations (SMIs) should be able to demonstrate at least equivalence in their testing methodologies to the relevant accreditation body. Public Health England is not an accrediting body in these circumstances therefore we do not hold information as to what tests are deemed to be equivalent to UK SMI B58.

UK SMIs are not mandatory and Public Health England does not have data as to how many laboratories, National Health Service or otherwise use UK SMI B58 or equivalent testing for detecting Group B Strep.

SMIs are intended as a general resource for practising professionals operating in the field of laboratory medicine and infection specialties in the United Kingdom.

SMIs help laboratories to meet accreditation requirements by promoting high quality practices which are auditable.

Public Health England has advised the Department that the UK Standard for Microbiology Investigation (SMI) B58 Detection of Carriage of Group B Streptococci was published in June 2015 and is available at:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/438182/B_58i3.pdf

SMIs are intended as a general resource for practising professionals operating in the field of laboratory medicine and infection specialties in the United Kingdom.

They represent neither minimum standards of practice nor the highest level of complex laboratory investigation possible, and are not mandatory. Laboratories can download and adapt the method into a Standard Operating Procedure (SOP) based on local policies. SMIs help laboratories to meet accreditation requirements by promoting high quality practices which are auditable. UK microbiology laboratories that do not use SMIs should be able to demonstrate at least equivalence in their testing methodologies to the relevant accreditation body.

SMI B58 describes the examination of specimens to detect carriage of Group B streptococci (GBS). SMI B58 states that it does not seek to contradict clinical guidelines from the Royal College of Obstetricians and Gynaecologists or the National Institute for Health and Care Excellence, or those of the UK National Screening Committee 2012 which did not recommend antenatal screening for GBS.

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced a Green-top guideline: Prevention of Early-Onset Neonatal Group B Streptococcal Disease. The Green-top guideline provides guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal group B streptococcal (GBS) disease. The first edition was published in 2003 and the second updated edition was published in 2012. An audit in partnership with the London School of Hygiene and Tropical Medicine and supported by the Royal College of Midwives was recently carried out by the RCOG. It examined current practice in preventing early- onset neonatal GBS disease by investigating the implementation of the RCOG Green-top guideline (2012 edition) and identified key areas for improvement. The first report was published on 5 March 2015 and found that the majority of obstetric units in the United Kingdom have written protocols to prevent early onset GBS disease in newborn babies. However, there is still variation in practice across units. The second report is due to be published later this year. Further information is available at:

https://www.rcog.org.uk/en/news/rcog-release-new-audit-into-gbs-finds-variation-in-practice-across-obstetric-units/

In addition the National Institute for Health and Care Excellence has published a clinical guideline which addresses early-onset GBS and other neonatal infections, ‘Antibiotics for early-onset neonatal infection: Antibiotics for the prevention and treatment of early-onset neonatal infection’ (August 2012).The clinical guideline is available at:

http://www.nice.org.uk/guidance/cg149

Information on GBS in pregnancy is publically available on the NHS Choices website at:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-infections.aspx. The RCOG has also developed public information on early onset GBS:

https://www.rcog.org.uk/en/patients/patient-leaflets/group-b-streptococcus-gbs-infection-in-newborn-babies/

In June 2015, Public Health England (PHE) published the paper, ‘Enriched culture medium test for group B streptococcus infection: position paper’. The paper concluded that within current accepted clinical guidelines, there are no indications for testing women using enriched culture medium (ECM) methods. Therefore the ECM test has not been introduced into PHE laboratories. The position paper is available on the gov.uk website at:

https://www.gov.uk/government/publications/group-b-streptococcus-infection-enriched-culture-medium-test

UK standards for microbiology investigations B58: Detection of carriage of Group B Streptococci, which was updated in June 2015, is publically available on the gov.uk website at:

https://www.gov.uk/government/publications/smi-b-58-processing-swabs-for-group-b-streptococcal-carriage