Culture of multiple intraoperative tissue samples is the standard of microbiological diagnosis of prosthetic joint infections. Recently, improved sensitivity of using prosthesis sonication method and molecular techniques has been reported in the literature. However, collecting the removed prosthesis as well as additional specimens for molecular analysis is not straightforward for the surgeons and assistants in the operation theatre. Our All-in-a-Box concept addresses the need for simple and unambiguous sampling of clinical specimens in the operating theatre, and to overcome the variation in sampling technique within and between surgical teams and across different hospitals.

The All-in-a-Box concept was developed in close cooperation between surgeons, their operating assistants, clinical microbiologists and molecular biologists in order to ensure the concept is easily implemented in the operating theatre, achieving high completeness, and being well preserved all the way to the laboratory.

All needed equipment, vials and forms are collected in a single box, and corresponding items are clearly color coded to further reduce the likelihood of confusion.

Boxes are designed to address the specific needs for either routine diagnosis or special demands as in clinical studies. Their design is based on large experience in connection with diagnosis of joint prosthesis-related infections. Downstream SOPs for sample processing are included in the All-in-a-box concept and specimens can subsequently be analyzed in parallel by culturing and molecular methods.

We have implemented this concept in two large research projects, we received 1508 (89%) of 1685 scheduled samples during the 2-year project period in the first project despite several different surgical teams and hospitals, while the other project is still ongoing.

All-in-a-Box is useful concept to improve the completeness of routine sampling for microbial analysis.