To swab or not to swab? A qualitative study of pathology testing, interpretation, and value in diabetes-related foot ulceration

Jennifer Broom; Leah Williams Veazey; Alex Broom; Lijie Kee; Keat Choong

doi:10.1016/j.idh.2023.10.002

To swab or not to swab? A qualitative study of pathology testing, interpretation, and value in diabetes-related foot ulceration

Infect Dis Health. 2024 Feb;29(1):39-50. doi: 10.1016/j.idh.2023.10.002. Epub 2023 Nov 27.

Authors

Jennifer Broom¹, Leah Williams Veazey², Alex Broom³, Lijie Kee⁴, Keat Choong⁵

Affiliations

¹ Infectious Diseases Service, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD 4575, Australia; School of Medicine, University of Queensland, Brisbane, QLD, 4072, Australia. Electronic address: jennifer.broom@health.qld.gov.au.
² Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, NSW, 2006, Australia. Electronic address: leah.williamsveazey@sydney.edu.au.
³ Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, NSW, 2006, Australia. Electronic address: alex.broom@sydney.edu.au.
⁴ Infectious Diseases Service, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD 4575, Australia. Electronic address: lijie.kee@health.qld.gov.au.
⁵ Infectious Diseases Service, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD 4575, Australia; Infection Research Network, Sunshine Coast University Hospital. 6 Doherty Street, Birtinya, QLD 4575, Australia. Electronic address: keat.choong@health.qld.gov.au.

PMID: 38016843
DOI: 10.1016/j.idh.2023.10.002

Abstract

Background: Diagnostic testing has been proposed as a key strategy to tackle escalating antimicrobial resistance (AMR). However, effectiveness of testing is limited by the complexities of the hospital environment, including human factors.

Objectives: To examine swab-testing in diabetes-related foot infections as a case study of the factors impacting microbiology testing use, efficacy, and antimicrobial resistance.

Methods: Seventeen clinicians involved in the management of diabetes-related foot infections, including podiatrists, nurses, and doctors, participated in in-depth individual interviews conducted by a qualitative researcher on the investigation and management of diabetes-related foot infections. Thematic analysis was performed.

Results: The multilayered and evolving features of the human-diagnostic interface were described by participants as potential barriers to effective swab-testing in clinical care, including diagnostic training and interpretation deficits; communication difficulties; interpretation deficits and diagnostic assumptions; the influence of inter-professional dynamics; and flow-on consequences for patient decisions and care.

Conclusions: Swab-testing has been used for over 100 years, and yet there remain substantial factors that limit their effective use in clinical practice as demonstrated by this study. A focus on upscaling diagnostic testing, particularly with escalating AMR, without considering complex implementation and human factors is likely to have limited impact on practice improvement. This study identified vulnerability points in the human-diagnostic interaction which should be considered in the implementation of other microbiological tests. This study on the simple wound swab has implications for future diagnostic upscaling and investment, including its role in address antimicrobial resistance.

Keywords: Antibiotic resistance; Antimicrobial stewardship; Diabetes complications; Specimen handling; Wound infection.

MeSH terms

Anti-Infective Agents*
Communicable Diseases*
Diabetes Mellitus*
Humans
Physicians*
Specimen Handling

Substances

Anti-Infective Agents