An audit of microbiology laboratory utilization: the diagnosis of infection in orthopedic surgery.

OBJECTIVE: To analyse the quality of ordering, collection and transport of specimens for microbiological analysis by a department of orthopedic surgery. METHODS: The analysis consisted of a prospective formal evaluation performed by two consultant microbiologists. RESULTS: One hundred and seventeen consecutive requests were audited. These requests belonged to 55 clinical episodes, 39 of which were of (presumed) infection and 16 of surveillance. The main sites sampled were: joint 28 (51%), and extra-articular bone or tissue 6 (11%). Of 98 surgical specimens, 20 (20%) yielded a relevant microorganism. The requests were classified as definitely appropriate in 67% and 85% of episodes, by the two consultants respectively. No request was considered unjustified. Collection, handling and transport were categorized as definitely appropriate in 56% and 73% of requests. Analysis of compliance with an existing protocol for prosthetic joint revision revealed similar errors. CONCLUSION: Audits of this type can give invaluable information about the area of uncertainty between the clinician and the laboratory and can identify appropriate measures for corrective action.