Abstract
To propose a national specification for hospitals which offer treatment of complex bone and joint infections to adults.
Patients with bone and joint infections are treated in a wide variety of hospitals in the UK. A few have developed services with infection physicians, microbiology laboratory support and dedicated orthopaedic and plastic surgeons working together to deliver a multidisciplinary care pathway. However, many patients are treated in non-specialist units leading to multiple, often unsuccessful procedures with long hospital stays, high costs and additional pain and disability. Inappropriate antibiotic therapy without adequate surgery risks antibiotic resistance.
A draft specification was written defining the types of patients who should be referred to a specialist unit for treatment. A description of the components which must be available to treat these cases (staffing, expertise, diagnostic support, outcome assessment and governance structure) was proposed. This draft was circulated to infection units in the UK for consideration and agreed with the Health Department in England.
Complex bone and joint infections would be best served nationally by 3–6 networks, each with a single specialist centre. This is similar to national arrangements for bone sarcoma treatment.
Patients to be referred will include those with:
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Chronic osteomyelitis (long bone, pelvis, spine)
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Chronic destructive septic arthritis
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Complex prosthetic joint infections (multiple co-morbidities, difficult/multi-resistant organisms, multiply operated or failed revision surgery)
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Infected fractures and non-unions
Specialist units should have:
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Orthopaedic surgeons who specialise in infection (joint revision, Ilizarov techniques, etc).
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Infection physicians who can treat medically unwell patients with complex co-mordidities and multi-resistant infections.
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Plastic surgeons with experience in difficult microsurgical reconstruction techniques.
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Scheduled (at least weekly) meetings of all of the above, with a radiologist to discuss new referrals and complex cases.
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A home IV therapy service.
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Dedicated in-patient beds staffed by infection trained staff.
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Multi-disciplinary (one-stop) out-patient clinics.
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Quality measures assessed, including PROMS, clinical success rates, and functional outcome.
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Education and research programmes.
This service specification is a tool for developing regional units. It facilitates the creation of designated centres in a national network (hub and spoke model). This service specification has been agreed and published by NHS England.
