240. Estimated Clinical and Economic Impact Through Use of an Initial Specimen Diversion Device to Reduce Blood Culture Contamination: A Cost–benefit Analysis

Abstract

BackgroundBlood culture contamination results in increased hospital costs and unnecessary patient-exposure to antimicrobials. We sought to evaluate the potential clinical and economic benefits of a novel blood culture diversion device when routinely utilized for blood culture collection in the emergency department (ED) of a quaternary care medical center.MethodsA decision analysis model was created. Probabilistic costs were determined from published literature and direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) after initial specimen diversion device (e.g., SteriPath) implementation in the ED using a hospital perspective. Indirect hospital costs included increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created for hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures.ResultsThe routine implementation of an initial specimen diversion device for blood culture collection in the ED was cost-beneficial compared with conventional blood culture collection methods and was also associated with a reduction in antibiotic usage, adverse drug reactions and hospital-acquired infections. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, initial specimen diversion device use was associated with a cost savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. Main drivers of cost included the baseline rate of contamination in the ED and the duration of antibiotics given to patients with negative blood cultures.ConclusionImplementation of an initial specimen diversion device is estimated to be a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy, and wider indirect hospital costs.Disclosures K. W. Garey, Merck & Co.: Grant Investigator, Grant recipient.