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UK standards for microbiology investigations

Chris Ward, IBMS Head of Examinations, and Ruhi Siddiqui, Head of the Standards Unit at the UK Health Security Agency, with the latest updates.

actinomyces viscosus bacteria CREDIT - science photolibrary

At a glance

  • The UK SMIs are a referenced collection of recommended algorithms and procedures for clinical microbiology.
  • Recommendations are based on evidence where available, expert opinion and pragmatism.
  • They are relevant to practising lab medicine professionals, clinicians and commissioners of healthcare services.

The UK Standards for Microbiology Investigations (UK SMIs) are a comprehensive, referenced collection of recommended syndromic algorithms for initial test selection, standard operating procedures for carrying out microbiology and virology tests together with testing and confirmatory strategies and they cover all the stages of the investigative process in microbiology.

They are a crucial National Institute for Health and Care Excellence (NICE)-accredited resource as they represent a good standard of practice, rather than a minimum standard of practice or highest level of complex laboratory investigation possible, to which all clinical and public health microbiology laboratories within the UK are expected to adhere. See box for the overall objectives of the UK SMIs.

These standards have been developed since 1996 by the collaborative efforts of working groups of experienced laboratory-based medical and scientific microbiologists and virologists from across the UK Health Security Agency (UKHSA) and the NHS.

There are currently around 100 documents with recent publications including ones on the Identification of Actinomyces species, red or painful eye, sepsis, and systematic or disseminated infections, the laboratory diagnosis of HIV infection, and the laboratory diagnosis of syphilis.

Each document is developed based on evidence where available and existing good practice where such evidence is not available and is a result of an extensive consultation process with organisations contributing to the development of the standards coming from across the UK, including the Association for Laboratory Medicine, British Infection Association, Healthcare Infection Society, Public Health Scotland, Public Health Wales and the Royal College of Pathologists.

The IBMS is also a key contributor to the development of each standard and responds to consultations sent out by the standards unit by sending them to the members of its Medical Microbiology and/or Virology Specialist Advisory Panels as appropriate for comments, which are then collated so that an Institute response can be submitted to the UK SMI Working Groups. The UK SMIs are also a standing item on the Medical Microbiology Advisory Panel, where the broad principles of good practice in microbiology laboratories are discussed.

The overall objectives

The overall objectives of the UK SMIs are to:

  • Provide good-quality evidence-based NICE-accredited standards for the investigation of infections for diagnostic and public health microbiology laboratories, without commercial company bias or emphasis.
  • Develop overarching documents based on the investigation of syndromes, which in turn are supported by more detailed guidance on the investigation of diseases and infections.
  • Develop, review and update UK SMIs through a wide consultation process where the views of all participants are considered, and the resulting documents reflect the majority agreement of contributors.
  • Advise commissioners of microbiological services on the range and standard they should require in their contracts with microbiology laboratories.
  • Provide the UK SMIs electronically as a one-stop shop for microbiology investigation.

There are three groups of users who will find the UK SMIs relevant to their work and, whilst it is not mandatory for the UKHSA or NHS laboratories to follow them, it is encouraged that they use their broad outline so that good practice can be maintained across the country.

The first group of users who benefit from using them are practising laboratory medicine professionals who can use them as a general resource. The second group of users are clinicians who can use them to help them order the appropriate tests for their patients and learn about the standard of the laboratory services they can expect for their patients. The third group of users are commissioners of healthcare services who can use them when planning the clinical and public healthcare packages for their populations.

Those undertaking the Specialist Diploma in Medical Microbiology should have an awareness of the UK SMIs and those doing the Higher Specialist Diploma (HSD) in Microbiology or Virology should be aware of recent publications and the recommendations that are made within them as they could form the basis for the essay questions for the portfolio or in the exams.

In October 2023, in a move driven by the requirements to comply with relevant accessibility regulations, which are designed to ensure that digital content is accessible to all users, the Royal

College of Pathologists website became the new home for the UK SMIs and the webpages where the standards were previously published has been decommissioned.

The Standards Unit maintains full control over the UK SMIs, and it will continue to make improvements to these webpages to ensure that they meet the evolving needs of their users. The UK SMI team greatly values user feedback. If you encounter any issues or have suggestions, please get in touch, via the details below.

Explore further

Email: [email protected]


IBMS resources:

Chris Ward is the IBMS Head of Examinations and Ruhi Siddiqui is the Head of Standards Unit at the UK Health Security Agency.

Image credit | Science Photolibrary

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