Thursday, April 28, 2005

Implementation of the 2002 Group B Streptococcus Screening Guidelines

Barbara E. Robinson-Dunn, Marcus Zervos, and JoAnn Logue-O'Malley.

Group B Streptococcus (GBS, Streptococcus agalactiae) has been a leading cause of neonatal morbidity and mortality but its incidence has decreased due to improved screening methods for pregnant women.

The 2002 Guidelines recommended increased testing of pregnant women-with the exclusion of the risk-based method of screening. An outcome of this recommendation was an unknown additional amount of work for stressed clinical microbiology laboratories. This project sought to fully implement the 2002 Guidelines while maintaining laboratory costs within budget.

The components of the GBS testing process were analyzed separately for a 967 bed community hospital to determine if each could be made more efficient. This included a ClinMicroNet survey to determine what tests other laboratories were performing, validation of a new culture medium (modified GBS agar) for rapid identification of GBS, analysis of those areas in which there could be a communication failure leading to lack of a final report on the patient's chart at the time of delivery.

After 4 months, a total of 569 specimens had been tested on modified GBS agar providing a more rapid and less expensive identification of GBS, computer reports had been altered to reflect improvements in testing methodology of vaginal-rectal specimens as well as changes in testing specimens of urine from pregnant women. Memoranda had been sent to healthcare providers and articles were placed in the Clinical Pathology newsletter to inform readers of the GBS testing changes. The result of these efforts was that the laboratory was able to provide a rapid identification and antibacterial susceptibility report for all isolates obtained from screening performed at 35-37 weeks of gestation. The additional work was accomplished without any increase in staffing.

Analysis and refinement of each step in the testing process can allow implementation of new techniques that enhance patient care.

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See more of The 2005 Institute for Quality in Laboratory Medicine Conference