Internal Reference Number: FOI_7742
Date Request Received: 09/02/2024 00:00:00
Date Request Replied To: 05/03/2024 00:00:00
This response was sent via: By Email
Request Summary: Joint infection services
Request Category: Companies
| Question Number 1: I am writing to request your assistance with an open government request relating to your joint infection services according to the Freedom of Information Act 2000. Please kindly complete the below questions. Questions for clinical team(s): 1. In 2022/2023 (or for the last recorded year with data available), in your Trust/Health Board, how many of the following did you record? a) Paediatric patients with suspected septic arthritis in native joints b) Paediatric patients with suspected prosthetic joint infection (PJI) c) Adult patients with suspected septic arthritis in native joints d) Adult patients with suspected prosthetic joint infection (PJI) | |
| Answer To Question 1: We are unable to reliably answer this question as suspected diagnoses are not clinically coded. | |
| Question Number 2: Does your Trust/Health Board follow or have any locally developed/adapted guidelines for the diagnosis and treatment of septic arthritis in native joints and prosthetic joint infections in both adults and paediatric patients? a) If yes, please state which guidelines have been adapted and please provide a copy of your local guidelines | |
| Answer To Question 2: No, we don’t have a specific Trust septic arthritis guideline or PJI guideline. | |
| Question Number 3: When investigating suspected septic arthritis in native joints in both paediatric and adult patients, is a synovial fluid sample collected before or after antibiotics are administered and commenced? a) Is joint aspirate collected in ED/triage, Assessment unit, inpatient ward, or theatre? b) Who typically performs the procedure and collects the sample? (Please specify job role) c) Does the above differ for suspected prosthetic joint infections? If yes, please clarify how this differs | |
| Answer To Question 3: This is very dependent on the situation. In adults we prefer to aspirate the joint before commencing antibiotics if it is a joint we can easily aspirate and the patient is stable. Young children are usually commenced on antibiotics without joint aspiration. a. If the patient has presented to ED and is an adult, and it is an easily aspirated native joint, then it would usually be aspirated in ED. However if they are already an in-patient on a ward on ITU, then they may be aspirated in that ward setting. b. by the orthopaedic registrar on-call. c. Suspected Prosthetic joint infections, young children, or joints such as hip which are not so easily aspirated would usually be done in theatre. | |
| Question Number 4: What clinician would typically manage paediatric patients with suspected septic arthritis in native joints? (please select one or multiple) I. Paediatric Consultant II. Orthopaedic Consultant III. Infectious Diseases Consultant IV. Other (please specify) | |
| Answer To Question 4: Paediatric patients with joint infection are usually managed under combined care of consultant paediatrician and consultant orthopaedic surgeon (I + II). | |
| Question Number 5: Are patients discharged before culture results from synovial fluid aspirate are received? If yes, what requirements need to be met before patients are discharged? | |
| Answer To Question 5: Consultant Microbiologist response - Yes, clinical risk assessment as to likelihood of diagnosis, results of gram stain, stability of patient. Consultant Trauma & Orthopaedic Surgeon response - patients may be discharged before culture results are back if stable, not in sepsis, clinically low suspicion of septic arthritis, satisfactory blood and clinical markers, and reassuring gram stain. | |
| Question Number 6: Questions for lab/diagnostic team(s): For adult and paediatric patients with suspected septic arthritis of native joints, what are the mean turnaround times (in hours, or if more appropriate, working days) for results on the following tests from receipt of specimen: (please provide an answer for each result) a) Gram Stain b) Culture c) Blood culture d) White blood cell count | |
| Answer To Question 6: a) varies as to when taken. There is no service overnight. If received during the day then usually results turned around within a couple of hours of receipt in the lab. May be expedited by clinical phone calls/discussion b) 48 hours to 72 hours but 7 days if broth culture done c) depends on when or if the blood culture bottle is positive on the machine – would potentially vary from 12 hours to 5 days d) no formal white cell count done in microbiology lab but there is a result as to whether there is none, +, ++, +++ | |
| Question Number 7: Does your Trust/Health Board conduct PCR testing of bacteria from synovial fluid of patients who have suspected septic arthritis of native joints? If yes: a) Is this testing conducted on site? b) At what point is testing requested – when the culture is negative or on request? c) How long is the average turnaround time for results from receipt of specimen? d) What organisms are routinely tested for? | |
| Answer To Question 7: Sometimes, if clinically indicated a) no b) mixture of request and no growth c) not formally audited but about 5 days d) 16S PCR | |
| Question Number 8: Does your Trust/Health Board conduct 16S PCR testing of bacteria from synovial fluid of patients who have suspected septic arthritis of native joints? If yes: a) Is this testing conducted on site? b) At what point is testing requested – when the culture is negative or on request? c) How long is the average turnaround time for results from receipt of specimen? d) What organisms are routinely tested for? | |
| Answer To Question 8: as for question 7 – the PCR test is 16S PCR | |
| Question Number 9: Joint question – input from both clinician and lab/diagnostic team: 9. For joint infections, in your Trust/Health Board, please confirm the following: a) Which roles or stakeholders are involved in the design of diagnostic pathways and introducing change/pathway improvement? b) Which team(s) hold the budget for investing and implementing in new technologies across the pathway (e.g. rapid diagnostic testing)? | |
| Answer To Question 9: a) Rheumatology, microbiology, orthopaedics b) microbiology/pathology, unless specific money comes in from the DOH to rheumatology or orthopaedics specifically for this. | |
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