Reducing Blood Culture Contamination Rates by Educational Intervention and one-on-one Feedback in the Emergency Department

Abstract

Background/Purpose Blood culture specimens collected from patients in the emergency department (ED) can subsequently give the clinical physicians useful information and references for diagnosis and medication selection. If the isolates are found to be contaminants, the consequences are increased antibiotic use and inpatient hospital fees. The purpose of this research is to reduce blood culture contamination (BCC) rates in the ED. Methods The effectiveness of educational intervention and one-on-one feedback to reduce BCC rates in the ED was assessed in a busy medical center in which blood cultures were obtained by nurses rather than trained phlebotomists. The study comprised two phases. The first phase was to ensure understanding of the correct methods for performing blood culture, and to measure the effectiveness of the educational intervention. The second phase was to continue the educational intervention plus to give one-on-one feedback of the BCC rates to the ED and individuals weekly. Results The baseline BCC rate was 3.4% in the pre-intervention period. The BCC rate fell to 2.67% in Phase 1 (i.e., educational intervention only). The BCC rate fell to 2% in Phase 2 (i.e., educational intervention plus one-on-one feedback). Among the contaminants, coagulase-negative staphylococci (CoNS) fell from 62% before the intervention to 48% post-intervention. Conclusion Educational intervention plus one-on-one feedback for decreasing BCC rates was more effective than an educational intervention alone in our study.