The Journal of Hand Surgery - European Volume - April 2018 - 14

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diagnosis and antimicrobial sensitivities within ninety
minutes. We aimed to review the existing evidence
for multiplex PCR in clinical microbiology and to discuss its potential role in managing patients with hand
& upper limb infections at our tertiary hand unit.
Methods: Comprehensive literature review was
undertaken using Medline and EMBASE. Search
terms included: 'multiplex PCR', 'hand surgery',
'hand infection', 'upper limb infection' and 'clinical
microbiology'. Relevant literature was then identified
and considered.
Results: There is no published literature examining
the use of multiplex PCR in patients with hand &
upper limb infections. Multiplex PCR has been used
in other specialties including: gastroenterology,
respiratory, neurology, trauma & orthopaedics and
burns. Related literature has shown benefits in
time to results of antimicrobial sensitivities in comparison to traditional culture techniques. Utilising
such technology in severe hand & upper limb infections has clear clinical implications: quicker identification of resistant organisms and administration of
appropriate antibiotic therapy, reduced inpatient stay
and less return to theatre.
Conclusions: There is no published literature considering the role of multiplex PCR in patients with
hand & upper limb infections. Following the introduction of this technology at our unit, we shall publish
our audit data on the change and improvement to
rapid diagnosis and its impact on clinical outcomes.
The benefits of using multiplex PCR in this setting
are clear and need to be explored further in all
specialities.

Hand Trauma Service at a Rural District General
Hospital. Challenges of Meeting the BSSH 2007
Hand Trauma Standards
Mr David Izadi, Mr Alasdair Barrie, Mr Kevin Williams,
Mr Vikram Devaraj, Mr Andrew Watts and
Mr Christopher Wallace
Royal Devon and Exeter Hospital
Time in programme: Friday 4th May 2018 09:53

Aims: In 2007, the British Society of Surgery of the
Hand established minimum standards for hand units
treating patients with hand trauma in the UK. An audit
of the hand trauma service at the Royal Devon and
Exeter Hospital in 2016 demonstrated a gross failure
to comply with these standards. We thus sought to
introduce new measures to improve the service.
Methods: The new measures implemented in 2016
restrictedA&E'saccess to week dayhand trauma

Journal of Hand Surgery (Eur) 43(Supplement 1)
clinics andinstead introduced a virtual triage clinic
run by the on-call consultant every morning. The
hand trauma clinic was relocated next to the hand
therapy clinic; new hand trauma patients needing
hand therapy were seen on the same day as their
hand trauma clinic appointment; new patientscould
be placed directly with hand therapists; dedicated
hand trauma onlyday case operating lists were
established. One year after the first hand trauma
clinic audit, the same audit was repeated for the
same period in 2017.
Results: Following implementation of the above
changes, 15 additional new, and 15 additional followup patients were seen in the hand trauma clinic each
month, and 13 additional hand trauma patients were
operated on each month, increasing thehand
trauma generated incomeby £29,000 per month.
There was a 50% improvement in the number of
patients seen in the hand trauma clinic within 5 days
of their referral, a 35% improvement in the number of
patients waiting less than 5 days for their surgery.
Conclusions: This audit loop demonstrates how the
introduction of a series of simple interventions can
significantly improve the service delivered to hand
trauma patients with a significant increase in the revenue generatedby this service.Weaim to re-audit this
service again to continue making further
improvements.

Current Opinions Regarding the Management of
Pyogenic Flexor Tenosynovitis
Miss Laura Bolton and Mr Chris Bainbridge
Nottingham City Hospital
Time in programme: Friday 4th May 2018 09:57

Aims: We aim to assess the management of pyogenic
flexor tenosynovitis(PFT) amongst attendees at the
British Society for Surgery to the Hand (BSSH) meeting in order to guide further research.
Method: An electronic survey was distributed to
attendees at the BSSH meeting. The survey was compiled by a group of hand surgeons and piloted in a
tertiary unit prior to dissemination. Questions
focused on three clinical vignettes describing PFT
of increasing severity. Responses were analysed
using Surveymonkey.
Results: Almost 50% of respondents would proceed
to surgical decompression and washout even in
patients diagnosed within a few hours of onset. This
increased to 88% when treating a patient who had
symptoms for several days and failed a trial of oral
antibiotics. The majority of respondents would not

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