Impact of Phlebotomist-Only Venipuncture and Central Line Avoidance for Blood Culture in a Large Tertiary Care University Hospital

Abstract

Background Drawing blood for culture from central vascular access sites may increase rates of blood culture contamination and central line–associated bloodstream infection. Methods We examined the impact of phlebotomist-only blood draws and central line avoidance for blood culture in a large university hospital that also cares for patients with cancer, stem cell transplants, and solid-organ transplants. Policy enforcement began in September 2013. The preimplementation era was defined from January 2012 to June 2013, and the postimplementation era was defined from January 2014 to September 2015. Outcomes in preimplementation and postimplementation eras were compared using time-series analyses, t tests, and Wilcoxon rank sum tests. Results Policy implementation led to 29%, 31%, and 38% decreases in blood culture performance, positivity, and contamination, respectively; an 86% decrease in blood cultures drawn from central lines; and a 66% decrease in central line–associated bloodstream infections. Our policy coincided with an 11% decrease in intravenous vancomycin, daptomycin, or linezolid use, whereas there was no change in piperacillin-tazobactam, cefepime/ceftazidime, or carbapenem use. Hospital lengths of stay and mortality rates were unchanged in the general hospital population and were stable or improved in patients with kidney disease, liver disease, cancer, and abdominal solid-organ transplants. Conclusions Our findings suggest that having phlebotomists draw blood for culture almost exclusively by venipuncture resulted in decreased blood culture positivity that did not translate into harm as measured by length of stay or inpatient death even among immunocompromised hosts.