National report finds some trusts failing to follow group B strep guidelines

July 17 2020

A national learning report has highlighted failures to follow national guidelines to prevent group B strep (GBS) infections in babies. The report was compiled by the Healthcare Safety Investigation Branch (HSIB) who identified the risks associated with group B strep during maternity investigations carried out in hospital trusts across England.

What is group B strep?

Group B streptococcus (GBS) is a naturally occurring infection, often found in a mother’s vagina or gut. This bacterium is found in up to 40% of the population where it causes no problem however, it can be dangerous for babies during labour and immediately after birth. Giving antibiotics to the mother during labour reduces the chance of the infection passing on to the baby.

RCOG guidelines not being followed

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced guidance on the treatment of mothers who are found to be carrying GBS. However, HSIB investigations found that mothers are not always provided with all the information on group B strep recommended in these guidelines. The report found that in some cases this limited clinicians’ ability to make decisions about using antibiotics during labour and pregnant women’s timely attendance to the hospital.

Investigations also observed maternity triage services encouraging mothers with newborn babies who had an increased risk of developing GBC, to stay at home for as long as possible. This was because information was not being shared between clinicians, the right questions were not being asked by the call receiver or due to problems with the documentation of a mother’s GBS status.

RCOG guidance suggests that mothers identified as carrying GBS should be seen earlier at the hospital so antibiotics can be given.

Positive tests not communicated effectively

The report also found problems where positive tests for GBS were not clearly communicated to the mother or noted clearly in her records. As a result, the recommended clinical care and antibiotics during labour were not given.

In addition to this, in some cases, the identification and escalation of care for babies who showed signs of GBS infection after birth was missed. The report stated that this has resulted in severe brain injury and death for some of the affected babies.

Hospitals must follow existing guidelines to improve care

The report strongly recommends that hospital trusts providing maternity care should consider the report’s findings and make immediate changes to their systems to ensure that mothers and babies receive care in line with RCOG national guidance.

Dr Louise Page, clinical adviser in the Maternity Team at HSIB said: “We have published this national learning report as a crucial part of HSIB’s role is to ensure that learning is seen at a national level. It helps trusts across the country to examine their own processes, make changes to ensure the safety of mothers and babies in their care and prevent devastating outcomes for families.”

Commenting on the report, Jane Plumb, chief executive of the charity Group B Strep Support, said: “Some of these tragedies may have been prevented if, for example, all expectant women were routinely provided with the information leaflet and if our ‘GBS Alert’ stickers were routinely used on the hand-held notes for all women known to be at higher risk of their newborn baby developing GBS infection.

“Trusts must implement the learning from these tragedies throughout their hospitals and with their staff – until that happens, avoidable group B strep infections will continue to cause untold and preventable heartbreak to families.”

Jane Brewin, Chief Executive of Tommy’s says: “Professional guidelines exist to improve maternity care for women and save babies’ lives. It is critical that every hospital trust follows these guidelines to ensure the UK delivers good maternity care to all women, no matter who they are or where they live.”

Up-to-date information for mothers and healthcare professionals can be found on the Royal College of Obstetricians and Gynaecologists, National Institute for Health and Care Excellence and Group B Strep Support websites.