Feasibility of using microbiology diagnostic tests of moderate or high complexity at the point - of - care in a delivery suite

Abstract

Point-of-care testing (POCT) is one of the fastest growing sectors of laboratory diagnostics. Most tests in routine use are haematology or biochemistry tests that are of low complexity. Microbiology POCT has been constrained by a lack of tests that are both accurate and of low complexity. We describe our experience of the practical issues around using more complex POCT for detection of Group B streptococci (GBS) in swabs from labouring women. We evaluated two tests for their feasibility in POCT: an optical immune assay (Biostar OIA Strep B, Inverness Medical, Princetown, NJ) and a PCR (IDI-Strep B, Cepheid, Sunnyvale, CA), which have been categorised as being of moderate and high complexity, respectively. A total of 12 unqualified midwifery assistants (MA) were trained to undertake testing on the delivery suite. A systematic approach to the introduction and management of POC testing was used. Modelling showed that the probability of test results being available within a clinically useful timescale was high. However, in the clinical setting, we found it impossible to maintain reliable availability of trained testers. Implementation of more complex POC testing is technically feasible, but it is expensive, and may be difficult to achieve in a busy delivery suite.

Keywords::

• Group B streptococcus
• microbiology
• point-of-care testing
• test complexity

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This work was funded by the UK National Institute for Health Research Health Technology Assessment Programme (HTA 02/38). The funding source had no involvement in study design, data collection, analysis and interpretation, writing of the report, or the decision to submit the paper for publication.