Training activity information
Details
Select, perform, and interpret tests for bacterial and fungal infections associated with the following specimens and suggest options for management:
- Bone and joint
- PD
- Ascitic fluids
- Sterile and non-sterile tissues
- Sterile and non-sterile fluids
- Shunts, lines and other prosthetic material
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- How will this DTA provide experience in processing and interpreting results from a variety of sterile and non-sterile body sites, including bone and joint, peritoneal dialysis (PD) fluid, ascitic fluid, tissues, fluids, shunts, lines, and other prosthetic material?
- What are the common bacterial and fungal pathogens associated with infections of these diverse sites?
- What is your understanding of the appropriate handling, processing, and testing methodologies for these different specimen types (microscopy, culture, identification, AST)?
- What specific skills in adapting standard microbiological techniques to these less common sample types do you hope to develop?
- How will you learn about the interpretation of results in the context of potential device-related infections?
- How will this activity enhance your ability to suggest management options for infections in these complex clinical scenarios?
- How will you prepare for this DTA?
- Will you review the laboratory guidelines for processing each of these specific specimen types?
- Will you discuss with your training officer the importance of communicating with clinical teams regarding the source of infection and potential for biofilm formation?
- What challenges might arise in interpreting results from non-sterile sites that may contain colonising flora?
- How will you approach the investigation of suspected prosthetic joint or intravascular line infections?
- How do you feel about the complexity of diagnosing infections associated with such a wide range of clinical presentations and sample types?
In action
- What specific bacterial and fungal infection tests are you currently performing or interpreting for these various sample types (e.g., Gram stain and culture of joint fluid, sonication fluid culture from a removed prosthetic joint, microscopy and culture of tissue biopsies)?
- How are you approaching the processing and testing of these diverse sample types? Why are you doing it this way (e.g., understanding the importance of specific processing techniques for different sample types to maximise pathogen recovery)?
- What decisions are you making regarding the interpretation of results in the context of potential contamination versus true infection?
- What aspects of processing and interpreting these tests feel intuitive to you, and what requires more conscious effort (e.g., differentiating skin commensals from true pathogens in tissue culture, interpreting results from semi-quantitative cultures of prosthetic material)?
- How effective are your current actions in obtaining or interpreting clinically relevant results from these varied specimens?
- What challenges are you facing during the process (e.g., low bacterial burden in some samples, interpreting the significance of coagulase-negative staphylococci)?
- What can you learn about diagnosing infections in these specific contexts and the challenges associated with them as the activity unfolds?
- How does this activity connect to your understanding of orthopaedic infections, peritoneal dialysis-associated infections, and device-related infections?
- Are there alternative approaches you could be considering if initial tests are negative but clinical suspicion remains high (e.g., recommending specific molecular tests on tissue, prolonged incubation of cultures)?
- What support or guidance might you need in this moment from a senior colleague or the training officer regarding the interpretation of culture results from unusual sites or the significance of specific organisms?
- Are you working within your scope of practice when selecting, performing, and interpreting these tests and considering management options?
On action
- Begin by summarising the key points of the experience working with these diverse sample types from bone, joints, fluids, and tissues.
- What were the most significant observations regarding the variability in sample processing, the techniques used (implicitly microscopy, culture, identification, AST), or the types of bacterial and fungal pathogens recovered?
- What skills or knowledge did you develop or improve through this DTA, specifically in processing these complex samples, applying standard techniques (microscopy, culture, identification, AST), interpreting results from challenging specimens, or suggesting management for infections in these sites?
- Were there any unexpected challenges (e.g., processing solid tissues, recovering slow-growing organisms, interpreting polymicrobial cultures) or successes?
- What did you learn from these? In what ways did your ‘reflection-in-action’ influence your approach during the activity, such as deciding on specific media for culture or the duration of incubation?
- What areas for continued development have been identified, particularly concerning processing specific sample types (e.g., bone, prosthetic material) or interpreting results from sterile vs non-sterile sites?
- How can you apply the learning from this activity to your routine practice when receiving and processing samples from these diverse sites?
- Identify the specific actions or ‘next steps’ you will take to enhance your proficiency with these sample types. What support or resources might you need to further develop in these areas?
Beyond action
- Revisit your initial reflect-on-action notes for this DTA.
- What additional insights have you gained since the initial reflection?
- Has discussing infections related to prosthetic material or complex fluid analyses with colleagues or clinicians altered your perspective?
- How did this specific testing experience compare to testing from more common sites?
- What unique challenges (e.g., processing tissues, interpreting cultures from lines, understanding the significance of isolates from non-sterile sites) have you identified across these diverse samples?
- Have you discussed diagnostics from bone/joint, fluid, or prosthetic material infections during professional discussions or clinical meetings? What new perspectives did this bring?
- How have the skills (e.g., selecting appropriate culture media and incubation conditions for different sample types, interpreting cultures from complex matrices, liaising with clinicians regarding sample source and clinical history) you developed during this DTA influenced your approach to other unusual or challenging samples?
- Have you applied the learning from this DTA, such as appreciating the need for specific processing techniques or understanding the clinical context of infection in these sites, to other aspects of your microbiology practice?
- How does the learning from this DTA contribute to your preparedness for processing samples from sterile sites?
- What transferable skills in adapting standard techniques to diverse and challenging sample types, interpreting results in complex clinical scenarios, and effective liaison with clinical teams, developed through this DTA, will be invaluable throughout your training and beyond?
- Identify clear actions for continued development related to the microbiology of bone/joint, fluid, or prosthetic infections based on your cumulative experiences and reflections.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Select and perform tests to investigate common infections from a range of sample types following guidance and fulfilling health and safety requirements |
| # 2 |
Outcome
Interpret the results of tests used to investigate common infections from a range of sample types with consideration of laboratory quality assurance and quality control |
| # 3 |
Outcome
Identify options for management of common infections based on test results and clinical context, considering infection control, guidelines and public health requirements |