Joint Infection Services - FOI Response Register

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?

NHS Shetland uses the ICD 10 coding system. Figures provided are for the number of inpatients where the given ICD 10 code was listed as Main Condition or Other Condition.

Please note whether M00 or T84.5 is applied is based on whether the infection and inflammatory reaction is due to internal joint prosthesis.

Where paediatric patients are defined as Age <18 and adult patient are defined as Age >= 18.

1. Paediatric patients with suspected septic arthritis in native joints

ICD 10 M00

Nil

2. Paediatric patients with suspected prosthetic joint infection (PJI)

ICD 10 T84.5

Nil

3. Adult patients with suspected septic arthritis in native joints

ICD 10 M00

3

4. Adult patients with suspected prosthetic joint infection (PJI)

ICD 10 T84.5

2

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?

No

a)      If yes, please state which guidelines have been adapted and please provide a copy of your local guidelines

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?

Yes, a sample is collected, ideally before antibiotics are administered.

1. Is joint aspirate collected in ED/triage, Assessment unit, inpatient ward, or theatre?

Most commonly in ED, sometimes in Theatre

2. Who typically performs the procedure and collects the sample? (Please specify job role)

Whichever doctor is on for A&E at the time, or the senior on call

3. Does the above differ for suspected prosthetic joint infections? If yes, please clarify how this differs

No

4. What clinician would typically manage paediatric patients with suspected septic arthritis in native joints? (please select one or multiple)

General Surgeons

I.      Paediatric Consultant

II.     Orthopaedic Consultant

III.    Infectious Diseases Consultant

IV.     Other (please specify)

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?

Yes, FBC, CRP and Gram stain results would have to be available and the patient discussed with a senior, prior to discharge

Questions for lab/diagnostic team(s):

6. 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 same day if arrives during routine working hours

b)      Culture – 48 hours

c)      Blood culture – 5 days if negative

d)      White blood cell count – <1 hours for ED samples

7. Does your Trust/Health Board conduct PCR testing of bacteria from synovial fluid of patients who have suspected septic arthritis of native joints? No

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?

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?

Can be referred at request and discretion of consultant microbiologist to another lab

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?

Joint question – input from both clinician and lab/diagnostic team:

9. For joint infections, in your Trust/Health Board, please confirm the following:

1. Which roles or stakeholders are involved in the design of diagnostic pathways and introducing change/pathway improvement?

Clinical teams in conjunction with others involved in the pathway.

2. Which team(s) hold the budget for investing and implementing in new technologies across the pathway (e.g. rapid diagnostic testing)?

Business case would be proposed and assigned where applicable.