1154 / The microbiological diagnosis of prosthetic joint and fracture-fixation device infections

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Diagnostics
Infection control / Prevention of surgical site infections There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Prosthetic joint infection (PJI) is a serious complication in orthopaedic surgery and requires an accurate microbiological diagnosis to ensure an adequate clinical management. The definition of PJI has not yet found a total consensus. A key role in the diagnosis is still played by microbiological investigations, contributing to the identification of infected cases and allowing the isolation and identification of the microorganisms responsible for infection and its antibiotic sensitivity. The Azienda Provinciale per i Servizi Sanitari (APSS) of Trento, in collaboration with the Italian Association of Clinical Microbiologists (AMCLI) aimed at releasing a guidance protocol for the diagnostic workup of PJI and fracture-fixation device infections (FFDI) in the microbiology laboratory.
Description of the Patient Safety Practice
 
Literature findings were integrated with the clinical experience coming from the major Italian orthopaedic centres for identifying pre-analytical and analytical procedures, as well as interpretative criteria for laboratory results. Protocols focused on number and type of pre-operative and intra-operative samples for obtaining optimal sensitivity and specificity. Sampling methods were identified according to clinical and laboratory requirements. Different procedural options were described for culturing articular fluid and prosthetic components in order to fit different microbiology laboratory settings and equipment availability.
Sampling, transportation, and preservation methods are detailed for articular fluid, perimplantar tissue, prosthetic components and fracture-fixation devices. Procedures and techniques for preventing sample contamination and cross-contamination are recommended. Minimal requirements for laboratory instrumentations are presented according to proposed protocols. Cultural methods for articular fluid include enrichment in liquid medium or direct inoculation in blood culture bottles. A minimum number of three tissue biopsies should be sampled from representative periprosthetic areas and cultures should include tissue homogenization, plating on solid media and broth enrichment. Biofilm dislodgment from removed prosthetic components and fracture-fixation devices is proposed by using sonication or elution with lytic solution. Incubation time is specified according to sample type and cultural method. Interpretative criteria are proposed for both quantitative and qualitative cultural results. Reporting of laboratory results is addressed in order to support the clinical diagnosis.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Regional or national level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple local/national health systems
Involved health care staff
 
Physicians
Nurses
Scientific staff / researchers
Clinical manager
Quality manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=4816
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Sharing of progress information among involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Iole Caola
Country: ITALY
Organisation: There is no specified text here
E-mail: iole.caola@apss.tn.it
Phone: There is no specified text here
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