Outbreak of Septic Arthritis Associated with Intra-Articular Injections at an Outpatient Practice - New Jersey, 2017

Safe Injection, Infusion, Medication Vial, and Point-of-Care Testing Practices in Healthcare (2025)

PURPOSE STATEMENT

This position paper provides healthcare professionals (HCP) updated guidance with corresponding evidence and rationale to support safe injection, infusion, medication vial, and point-of-care testing practices in healthcare settings. It addresses the infection risks associated with these practices but does not address other safety issues such as right dose, right site, right medication, phlebotomy, or intravenous catheter care. This document updates the Association for Professionals in Infection Control and Epidemiology (APIC) 2016 position paper.

The contribution of metagenomic next-generation sequencing to a diagnosis of gas-producing Fusobacterium-induced septic hip arthritis: A case report

Pyogenic arthritis with gas gangrene triggered by intra-articular steroid injections can occasionally result in fatal complications. Clostridium perfringens is typically the causative pathogen, with infections caused by Fusobacterium species being relatively rare. Fusobacterium species are known to cause pyogenic infections, but due to their extreme sensitivity to oxygen, they can be difficult to detect with traditional culture methods. Recently, metagenomic next-generation sequencing (mNGS) has gained attention as an alternative diagnostic tool to traditional culture, enabling rapid identification of causative pathogens in infectious diseases, including pyogenic arthritis. Its use is illustrated in the following case report, which demonstrates the diagnostic utility of mNGS in pyogenic arthritis with gas gangrene triggered by an intra-articular steroid injection. Using mNGS as a complement to conventional culture testing allows for a more precise narrowing-down of causative pathogens, enabling targeted therapy and improving patient outcomes. This approach may also help reduce the use of broad-spectrum antibiotics and prevent the emergence of antibiotic-resistant bacteria.

Impact of dual neutralization of TNF-α and IL-1β along with Gentamicin treatment on the functions of blood and splenic neutrophils and its role on improvement of S. aureus induced septic arthritis

Researches of recent past years have emphasized potential of antibiotics to improve septic arthritis but as multi-drug resistant strains like MRSA are emerging fast, new alternative therapeutic advances are high in demand. This study aims to figure out the role of neutrophils in regulating inflammatory responses of S. aureus induced septic arthritis while using TNF-α Ab or IL-1β Ab along with antibiotic gentamicin or both in combination. In this study, role of anti-oxidant enzymes were investigated and correlated with generated ROS level. While expression of TLR2, TNFR2, MMP2, RANKL, SAPK/JNK in the spleen were evaluated through western blot. Serum activity of IL-8, IL-10, IL-12, OPG, OPN, CRP was assessed using ELISA. Flow cytometry study evaluated inflamed neutrophil population. Results have shown TNF-α neutralization along with gentamicin was able to reduce arthritic swelling prominently. While combination therapy effectively reduced blood neutrophil ROS activity, arginase activity, MPO activity along with spleen bacterial burden. Serum OPG, CRP, IL-10 level got reduced while serum OPN, IL-8 and IL-12 level enhanced in treatment groups, showing mitigation of inflammatory damage. Overall, it is a novel work that observed how antibiotic and antibody therapy enhanced neutrophil function positively to combat sepsis. This study may not be fully applicable in clinical trials as it is performed with animal model. Clinical trials include crystalline and inflammatory arthritides, trauma, neoplasm. Interdisciplinary collaboration between radiology, orthopaedic surgery and knowledge of animal system responses may give better idea to find proper therapeutic approach in future research works.

How safe are intra-articular corticosteroid injections to the hip?

BACKGROUND

Intra-articular corticosteroid injections (ICSI) are an effective symptomatic treatment for osteoarthritis of the hip. However, the safety of ICSI has been questioned and a relatively high risk for septic arthritis, rapidly progressive osteoarthritis (RPIO) and periprosthetic joint infections (PJI) in patients undergoing subsequent total hip arthroplasty (THA) have been suggested.

METHODS

This is a retrospective evaluation of 682 hips that underwent ICSI with 40 mg of Triamcinolone for primary osteoarthritis of the hip. All ICSI were performed using sterile techniques, the number of ICSI in each hip and the cumulative corticosteroid dosage were assessed. Pre- and post-injection radiographs were compared to identify cases with RPIO. Native joint septic arthritis, surgical site infections and PJI were identified by chart review.

RESULTS

4 hips (0.6%) developed RPIO 2-4 months following ICSI. The cumulative Triamcinolone dose was not associated with the development of RPIO (p = 0.281). 1 case was diagnosed with septic arthritis and treated with staged THA, there were no signs of infection at a 5 years follow-up. 483 hips (75.7%) underwent THA, including 199 hips with THA less than 3 months following ICSI and 181 hips with > 1 ICSI prior to THA. There were 3 superficial surgical site infections/wound dehiscence and no PJI.

CONCLUSION

The rate of RPIO was 0.6%. The current findings suggest that if ICSI is performed under sterile conditions, the risk for septic arthritis or PJI following THA, even in patients with multiple ICSI or ICSI within 3 months prior to surgery, is minimal.

Construction and evaluation of a clinically relevant model of septic arthritis

Despite the creation of several experimental animal models for the study of septic arthritis, a protocol detailing the development of a reliable and easily reproducible animal model has not yet been reported. The experimental protocol described herein for the development of a clinically relevant mouse model of septic arthritis includes two main study stages: the first stage consisting of the preparation of the mice and of the methicillin-resistant Staphylococcus aureus (MRSA) cultures, followed by direct inoculation of MRSA into the knee joints of C57BL/6J mice (25-40 min); and a second study stage consisting of multiple sample collection and data analysis (1-3 days). This protocol may be carried out by researchers skilled in mouse care and trained to work with biosafety-level-2 agents such as MRSA. The model of septic arthritis described here has demonstrated clinical relevance in developing intra-articular inflammation and cartilage destruction akin to that of human patients. Moreover, we describe methods for serum, synovial fluid and knee joint tissue analysis that were used to confirm the development of septic arthritis in this model, and to test potential treatments. This protocol confers the advantages of enabling granular evaluation of the pathophysiology of MRSA infection and of the efficacy of therapeutic medications; it may also be employed to study a range of native joint diseases beyond inflammatory pathologies alone.

Septic arthritis of the hand: From etiopathogenesis to surgical treatment

BACKGROUND

Septic arthritis of the hand, which is the second most common after damage of the knee joint, remains one of the leading causes of temporary disability. An inflammation can cause dysfunction of the joint, and in the most severe cases, the need for amputation of the finger may arise. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory. Urgent surgical treatment is extremely important in septic arthritis of the hand, as it helps to prevent cartilage destruction and the development of osteomyelitis.

AIM

To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results, depending on the nature of the damage to the articular structures.

METHODS

The results of the treatment of 170 patients with septic arthritis of the hand, which were treated in the period of 2020-2021, were analyzed. Inflammation of the interphalangeal and metacarpophalangeal joints (MCP) of fingers 1, 2, and 3 was more often noted in 147 (81.6%) joints. The most common cause of arthritis was a penetrating injury as a result of household trauma (101, 59.4%), animal bite (30, 17.6%), and clenched fist injury (15, 8.8%). Septic arthritis with contiguous osteomyelitis was observed in 98 (54.4%) cases. Surgical treatment was completed with drainage and irrigation of the joint. Early mobilization was used to restore function. In patients with osteomyelitis, it was aimed at the formation of neoarthrosis. Arthrodesis was not applied. Long-term results of treatment were assessed in 142 (83.5%) patients within 1 mo to 12 mo after discharge from the hospital [the median was 7 mo (IQR: 4-9)].

RESULTS

The most commonly isolated organism was Staphylococcus aureus (35.3%). The median treatment delay in patients without osteomyelitis was 5 d (IQR: 4-7); for septic arthritis with contiguous osteomyelitis, it was 14 d (IQR: 5-21). Radiography for osteomyelitis within 2 wk was uninformative: 41.2% of diagnoses. A single surgical treatment was required in 138 (81.2%) patients, two treatments in 22 (12.9%), and three or more in 10 (5.9%). Total elimination of the infection was achieved in 163 (95.9%) patients. The best functional results of treatment were noted in patients without osteomyelitis. After septic arthritis, Total Active Motion (TAM) for the MCP was 96.2% (IQR: 85.1-98.0), for the proximal interphalangeal joint (PIP) 82.4% (IQR: 54.5-98.5), and for the distal interphalangeal joint (DIP) 69.4% (IQR: 65.4-74.1). In cases with osteomyelitis, it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2% (IQR: 45.3-90.1), for PIP-62.5% (IQR: 41.8-68.9), and for DIP-59.4% (IQR: 50-62.1). Additionally, the severity of pain during movements did not exceed 1 point.

CONCLUSION

The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis, especially in the presence of diabetes mellitus. Urgent surgical treatment, along with continued irrigation of the joint and antibiotic therapy, made it possible to eliminate the infection, and early rehabilitation restored the range of motion. The best results were noted in patients without osteomyelitis. With the development of osteomyelitis, a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis, without resorting to arthrodesis.

Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment

Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger. They rank second in the frequency of occurrence after lesions of the knee joint. Many points concerning the etiology, the timing of the development of cartilage destruction and the development of osteomyelitis, approaches to surgical treatment, the duration of antibiotic therapy, and the start of rehabilitation measures remain the subject of numerous discussions. Based on a search in the PubMed, Web of Science and Google Scholar databases down to 1990-2021, publications on septic arthritis of the hand were found and analyzed. The following inclusion criteria were used in our review: (1) Septic arthritis of the hand; (2) Published in a peer review journal; (3) Written in English; and (4) Full text version available. Studies were excluded if they met any of the following criteria: (1) Letters; (2) Articles published in abstract form only; and (3) Cadaveric studies. Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers (> 50% of cases). Up to 90% of cases, the infection enters the joint as a result of penetrating trauma, animal bites, etc. Staphylococcus aureus became the most frequently isolated microorganism (30%-55%), and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found, according to various sources, from 0% to 73% among all isolated Staphylococcus aureus. In arthritis, Pasteurella multocida (6%-11%) is often isolated as a result of animal bites. Articular cartilage destruction in the experiment developed within 24-48 h after infection. In clinical studies, the development of osteomyelitis was noted when treatment was delayed by more than 10 d. X-ray data during the first two weeks were uninformative. Priority of surgical treatment of septic arthritis. Drainage and surgical treatment, and with the development of osteomyelitis, the implementation of arthrodesis. Antibacterial therapy for 2-4 wk and early start of rehabilitation measures. Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.

Preparation of epigallocatechin gallate decorated Au-Ag nano-heterostructures as NIR-sensitive nano-enzymes for the treatment of osteoarthritis through mitochondrial repair and cartilage protection

Osteoarthritis (OA), a widespread degenerative disease characterized by cartilage destruction, has emerged as a public health challenge in the current aging society. In addition to applied steroids and surgery, near-infrared (NIR) sensitive nano-enzyme for the treatment of osteoarthritis through mitochondrial repair and cartilage protection is attractive and promising. In this study, a NIR sensitive multifunctional heterostructure (EGCG (Epigallocatechin gallate) decorated Au-Ag nano-jars (E@Au-Ag)) was introduced as an enzyme-sensitive active nanoplatform for the treatment of osteoarthritis. Molecular biology results indicated that E@Au-Ag possesses intrinsic properties of anti-oxidative stress and was able to reduce the apoptosis rate of chondrocytes by 83.3%. The area of the intra-articular joint cavity injected with E@Au-Ag can be elevated to 46.6 °C under NIR to promote the release of EGCG further to induce cartilage regeneration. X-ray radiography and section staining showed that E@Au-Ag reduced cartilage damage and decreased OARSI scores by approximately 52% after 8 weeks of treatment in a surgically induced OA model. The results demonstrated that this multifunctional enzyme-like nanoplatform with a synergistic NIR sensitive property to facilitate cartilage migration and regeneration repair provides a promising OA treatment strategy. STATEMENT OF SIGNIFICANCE: 1. NIR-sensitive nano-enzyme is gaining much attention in the field of biomedical materials. 2. EGCG decorated Au-Ag nano-heterostructures were utilized as NIR-sensitive nano-enzymes for the treatment of osteoarthritis through mitochondrial repair and cartilage protection. 3. The obtained multifunctional Au-Ag nano-heterostructures are promising for osteoarthritis treatment.

Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital

BACKGROUND

Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated  to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice.

METHODS

Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered.

RESULTS

We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3  (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency.

CONCLUSION

The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees  performed in a multispecialist dedicated center.

Devastating Pneumococcal Arthritis of the Shoulder After Two Corticosteroid Injections

A 36-year-old man was treated with two intraarticular corticoid injections for intense pain and severely decreased range of motion of his left shoulder. After the second injection, he came back with fulminant arthritis. Microbiological examination revealed streptococcus pneumoniae. Open debridement, long-term antibiotics, and total shoulder replacement were necessary to restore acceptable shoulder function. The fulminant course with rapid destruction of the joint illustrates the risks of intraarticular corticoid injections. This case also shows that the diagnosis should be accurately made and risk factors excluded before considering injection as a treatment.

Surgery's role in contemporary osteoarticular infection management

The treatment paradigm for osteoarticular infections (OAIs) has changed drastically over the past 80 years, from the advent of penicillin to the use of broad-spectrum antibiotics. Before these drugs, surgery was the only available treatment for OAIs; today, antibiotic therapy is considered the primary response to them. As a result, surgical treatment of OAIs is thus far more rarely indicated, sometimes even considered outdated and obsolete. However, long experience has taught us that many OAI contexts can still benefit from surgical management, constituting an essential complement to medical treatment. The present article seeks to contextualize this discussion by providing a chronological review of the surgical treatments used in cases of OAI and describing the quality of evidence supporting their rehabilitation in well-established situations.

Non-gonococcal septic arthritis of native joints in Western Australia. A longitudinal population-based study of frequency, risk factors and outcome

OBJECTIVE

To describe the incidence and long-term outcome of non-gonococcal septic arthritis (SA) in Western Australia (WA).

METHODS

Newman criteria were applied to define culture-positive SA and suspected SA cases in the state-wide West Australian Rheumatic Diseases Epidemiological Registry with longitudinally linked health data for patients >16 years with a first diagnostic code of pyogenic arthritis (711.xx [ICD-9-CM] and M00.xx [ICD-10-AM]) between 1990-2010. Annual incidence rates/100 000 (AIR) and standardized (against WA population) mortality rates/1000 person-years (SMR) and outcomes during 10.1 years follow-up are reported.

RESULTS

Among 2633 SA patients (68.6% male, age 47.4 years), 1146 (43.5%) had culture-positive SA. The overall AIR for culture-positive (1.6-6.3) and total SA cases (4.3-12.9) increased between 1990 and 2010 as did age at onset (39.5-54 years) and proportion of females (23-35.6%). Knees (33.6.%) were most frequently affected and 37.1% of cultures showed microorganisms other than Gram-positive cocci. Thirty-day rates for readmission and mortality were 25.4% and 3.2.%. During follow-up rates for serious infections (56.4%), osteoarthrosis (5.2%) and osteomyelitis (2.7%) were higher in culture-positive SA. SMR was increased for all SA patients but especially in those 17-40 years of age with culture-positive SA (24.2; 95% CI 2.3-261).

CONCLUSIONS

The incidence of SA in WA has risen steeply over 20 years. SA now occurs at higher age, affects females more often with over a third of cases caused by Gram-negative microorganisms. Not only culture-positive, but also suspected SA led to increased bone/joint complications, in-hospital and late mortality.

Septic Iliopsoas Bursitis After Intra-articular Methylprednisolone Injection to the Hip: A Case Report

CASE

We describe the case of a 74-year-old man who developed severe hip pain several days after an intra-articular methylprednisolone injection to his right hip. Culture of the ipsilateral iliopsoas bursa revealed a Staphylococcus lugdunensis infection, which was successfully eradicated through irrigation and debridement as well as antibiotics.

CONCLUSION

Infection after hip injection is a known theoretical risk but is rarely reported in the literature. We present a case of septic bursitis after corticosteroid injection. Readers should be mindful that these complications do occur in clinical practice and portend significant morbidity.

Novel therapeutic interventions towards improved management of septic arthritis

Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).

In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.

The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

Referrals of Infection Control Breaches to Public Health Authorities: Ambulatory Care Settings Experience, 2017

BACKGROUND

Beginning in October 2016, the Centers for Medicare & Medicaid Services (CMS) issued expanded guidance requiring accrediting organizations and state survey agencies to report serious infection control breaches to relevant state health departments. This project sought to characterize and summarize The Joint Commission's early experiences and findings in applying this guidance to facilities accredited under the ambulatory and office-based surgery programs in 2017.

METHODS

Surveyor notes were retrospectively reviewed to identify individual breaches, and then the Centers for Disease Control and Prevention's Infection Prevention Checklist for Outpatient Settings was used to categorize and code documented breaches.

RESULTS

Of 845 ambulatory organizations, 39 (4.6%) had breaches observed during the survey process and reported to health departments. Within these organizations, surveyors documented 356 breaches, representing 52 different breach codes. Common breach domains were sterilization of reusable devices, device reprocessing observation, device reprocessing, disinfection of reusable devices, and infection control program and infrastructure. Eight of the 39 facilities (20.5%) were cited for not performing the minimum level of reprocessing based on the items' intended use, reusing single-use devices, and/or not using aseptic technique to prepare injections.

CONCLUSION

The CMS infection control breach reporting requirement has helped highlight some of the challenges faced by ambulatory facilities in providing a safe care environment for their patients. This analysis identified numerous opportunities for improved staff training and competencies as well as leadership oversight and investment in necessary resources. More systematic assessments of infection control practices, extending to both accredited and nonaccredited ambulatory facilities, are needed to inform oversight and prevention efforts.

Patient Notification Events Due to Syringe Reuse and Mishandling of Injectable Medications by Health Care Personnel-United States, 2012-2018: Summary and Recommended Actions for Prevention and Response

OBJECTIVES

To summarize patient notifications resulting from unsafe injection practices by health care personnel in the United States and describe recommended actions for prevention and response.

PATIENTS AND METHODS

We examined records of events involving communications to groups of patients, conducted from January 1, 2012, through December 31, 2018, in which bloodborne pathogen testing was recommended or offered because of potential exposure to unsafe injection practices by health care personnel in the United States. Information compiled included: health care setting(s), type of unsafe injection practice(s), number of patients notified, number of outbreak-associated infections, and whether evidence suggesting bloodborne pathogen transmission prompted the notification. We compared these numbers with a similar review conducted from January 1, 2001, through December 31, 2011.

RESULTS

From 2012 through 2018, more than 66,748 patients were notified as part of 38 patient notification events. Twenty-one involved exposures in non-hospital settings. Twenty-five involved syringe and/or needle reuse in the context of routine patient care; 11 involved drug tampering by a health care provider. The majority of events (n=25) were prompted by identification of unsafe injection practices alone, absent any documented infections at the time of notification. Outbreak-associated hepatitis B virus and/or hepatitis C virus infections were documented for 11 of the events; 8 involved patient-to-patient transmission, and 3 involved provider-to-patient transmission.

CONCLUSIONS

Since 2001, nearly 200,000 patients in the United States were notified about potential exposure to blood-contaminated medications or injection equipment. Facility leadership has an obligation to ensure adherence to safe injection practices and to respond properly if unsafe injection practices are identified.

Infection prevention and control core practices: A roadmap for nursing practice

The CDC continues to stress the urgent issue of increasing microbial resistance. The organization recently joined forces with the American Nurses Association to bring awareness to this issue through an approach that prevents inappropriate antibiotic use and stresses infection prevention.

Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain-New Jersey, 2017

BACKGROUND

In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.

METHODS

An infection prevention assessment of the implicated facility's practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.

RESULTS

We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.

DISCUSSION

Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.

CONCLUSIONS

This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.

Retrospective Analysis of Septic Arthritis Caused by Intra-Articular Viscosupplementation and Steroid Injections in a Single Outpatient Center

Background

Septic arthritis is defined by the presence of pathogen(s) in a joint by direct inoculation or hematogenous spread. Most common organisms include Staphylococcus aureus and Escherichia coli. Clinical presentation is fever, warmth and night pain, with most common joints involved being the knee and hip. Iatrogenic septic arthritis is an uncommon complication of intra-articular injection for osteoarthritis yet its complications can be devastating. We aim to highlight ten cases of iatrogenic septic arthritis in retrospective study reviewing symptoms, signs, laboratory data, causing organisms and reasons leading to those infections.

Methods

Retrospective analysis of charts of ten patients who were admitted to Jersey Shore University Medical Center with diagnosis of iatrogenic septic arthritis.

Results

Average age of patients is 69.9 years. Most common comorbidities seen in our patient were hypertension and diabetes mellitus. The most common intra-articular agents that were injected were cortisone and Synvisc. The mean incubation period was 11.9 days. Most common presenting symptoms were joint pain and swelling. The most common organism isolated in cultures was Streptococcus mitis. A total of 100% of patients underwent surgical intervention for septic arthritis. One case was complicated by sepsis.

Conclusions

Iatrogenic septic arthritis is not common; however its complications can be catastrophic to patients. Improper sterile techniques and untrained physicians are the main risks factors for this complication. Physicians should take proper sterile measures to avoid complications of intra-articular injections.

Interpretation and clinical practice of regulation for prevention and control of healthcare associated infection in outpatient and emergency department in healthcare facilities

Healthcare associated infection (HAI) control and prevention is the important component of medical safety. Healthcare workers (HCWs) are the core forces for implementing good HAI control and prevention. Several cases of outbreaks occurred in outpatient and emergency department (OED) strengthened the importance of infection control and prevention. Recently, the "Regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities" was released by National health Commission of the People's Republic of China on May 10, 2018 and was going to implement on Nov 1, 2018. This regulation stipulates basic infection prevention requirements for safe care in OED of healthcare facilities. In this article, we would provide the interpretation and clinical practice of regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities and give a summary introduction.

Confronting barriers to improve healthcare literacy and cultural competency in disparate populations

Positive patient outcomes depend on clear communication. Understanding healthcare literacy, cultural competency, and health disparities/inequalities is essential for providing empathetic care to patients and their family members. Guidelines to provide culturally competent care may enhance the patient experience and improve healthcare provider communication.

Septic arthritis due to oral streptococci following intra-articular injection: A case series

Oral streptococcal species are a rare cause of septic arthritis. We describe 4 cases of septic arthritis due to oral streptococcal species following joint injection. The routine use of face masks during joint injection may prevent this rare but serious complication.

Infection Prevention and Control Core Practices: A Roadmap for Nursing Practice

In 2017, the CDC released a set of Core Practices focusing on infection prevention and control relevant for care delivered in all settings. These eight Core Practices address foundational elements of practice and should be embedded into every aspect of nursing care and part of every nurse's professional development plan.

Joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with severe hemophilic arthropathy of the knee: Is this intervention really effective?

The aim of this review is to explore the scientific rationale and evidence for a potential benefit of joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with severe hemophilic arthropathy of the knee (SHAK). Areas covered: This article is a narrative review of the evidence for potential benefits of joint lavage followed by intra-articular injection of hyaluronic acid and corticosteroids in SHAK compared with osteoarthritis of the knee in non-hemophilia patients. Expert commentary: Although some reports on hemophilic arthropathy with a low-grade of evidence seem to indicate a benefit of joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with SHAK, the short-lived improvements afforded by hyaluronic acid, and the doubtful benefits of corticosteroids and joint lavage in hemophilia, do not warrant their use in hemophilic patients. The scientific rationale of these procedures is poor and they are not recommended.

Outpatient Infection Prevention: A Practical Primer

As more patients seek care in the outpatient setting, the opportunities for health care-acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas.