Reduction of False-positive Blood Culture Rates Using a Passive Blood Diversion Device in an Urban Academic Pediatric Emergency Department

Abstract

Background Blood cultures contaminated with common commensals during collection contribute to antibiotics overuse, return visits to the Emergency Department (ED), and increased overall medical costs. There are published quality improvement projects aimed at implementing best practices to reduce false positive blood culture (FPBC) rates in adults, but literature is lacking in pediatrics, and few studies include the use of passive diversion devices designed to remove an aliquot of blood likely to contain skin flora. FPBC rates in our pediatric ED range from 0.45% to 5.63%. Our FPBC institutional goal is Methods In an urban, academic, freestanding pediatric hospital, the ED has 35,000 patient encounters and obtains 2800 blood cultures annually. In each study period, passive blood diversion devices were bundled with collection supplies. Education with best practices for technique, use of the device, and instructions to record device non-use were provided. Positive blood culture results were reviewed by the Infection Preventionist to determine true infection versus FPBC. Results In the first study period, 341 blood cultures were drawnwith an overall FPBC rate of 1.5%. The rate of FPBC when the device not used was 10.5% (4 of 38). In the second study period, 905 blood cultures were drawn with an overall FPBC rate of 0.22%. The rate of FPBC when the device not used was 6.06% (2 of 33). Zero FPBCs occurred with device use in each study period (0 of 303) and (0 of 874). Conclusions This significant reduction (by Fisher's exact test p = 0.0001) suggests that employing a passive blood diversion device in addition to targeted education may decrease FPBCs; antibiotics overuse, costs, and return visits in the pediatric ED setting.