Blood Culture Contamination: Educational Roadmap to Improvement

Abstract

BACKGROUND Blood culture contamination (BCC) leads to diagnostic uncertainty in clinical management. It contributes to increased health care costs, prolong hospitalization, delay or incorrect changes to patient management and increase laboratory workload. Research indicates average cost for contaminated blood culture $6,000. September 2014 the Emergency Department (ED) BCC rate was 6.4% compared to the current national benchmark rates 2-3% (Avg. 2.5%). METHODS Collaboration with ED nurse educators, Micro Consolidation Laboratory leader, and Infection Preventionist utilizing Continuous Quality Improvement (CQI) methodology resulted in the development of an educational program utilizing evidence based practice, a focus on standardization of process bundling of supplies, improved Blood culture specimen equipment, and updating BCC reporting systemto better monitor infection rates at staff level. A consistent process was established, blood culture collection kits created, all staff attended mandatory training, feedback provided to staff monthly along with coaching, mentoring, and re-education of staff with contaminants implemented. RESULTS Pre implementation ED BCC rates 6.4% support the hypothesis that basic asepsis principles were not understood or followed, there was a lack of knowledge related to good blood culture blood sampling practice, inconsistent processes by all staff members, and lack of understanding the importance for appropriate timing for drawing sample related to start of antibiotics. Blood culture contamination rates decreased following mandatory education and monthly monitoring of individual contamination rates, ongoing coaching, mentoring and re-education when appropriate. Post implementation ED was able to decrease BCC rates to yearly department rate of 2.5% for 2015. The ED has sustained this improvement through 2018 with consistent monthly rates less than 2% and as low as 0.7%. CONCLUSIONS An evidence based bundle approach, consistent implementation, ability to provide staff level BCC rates along with appropriate feedback, mentoring, coaching will support a sustainable improvement in BCC rates in the ED.