Abstract
Background: Blood cultures are indispensable for detecting life-threatening bacteremia. Blood cultures can become contaminated, which increases health care costs and antimicrobial resistance. Little is known about associations between contamination rates and topical disinfectants for blood collection in adults. Objective: We sought to determine whether a change in topical disinfectants was associated with the rates of contaminated blood cultures in the emergency department of a single institution. Methods: This single-center, retrospective observational study of consecutive patients aged 20 years or older was conducted in the emergency department (ED) of a university hospital in Japan between August 1, 2018 and September 30, 2020. Pairs of blood samples were collected for aerobic and anaerobic culture from the patients in the ED. Physicians selected topical disinfectants according to their personal preference before September 1, 2019; alcohol/chlorhexidine gluconate (ACHX) was mandatory thereafter, unless the patient was allergic to alcohol. Regression discontinuity analysis was used to detect the effect of the mandatory usage of ACHX on rates of contaminated blood cultures. Results: We collected 2,141 blood culture samples from 1097 patients and found 164 (7.7%) potentially contaminated blood cultures. Among these, 445 (20.8%) were true bacteremia and 1,532 (71.6%) were true negatives. Puncture site disinfection was performed with ACHX for 1,345 (62.8%) cases and with povidone-iodine (PVI) for 767 (35.8%) cases. The regression discontinuity analysis showed that mandatory ACHX usage significantly reduced the blood culture contamination rate by 9.6% (95% confidence interval (CI): 5.0%–14.2%, P <0.001). Conclusion: Rates of contaminated blood cultures were significantly lower when ACHX was used as the topical disinfectant. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: We have no conflicts of interest to disclose. Ethics Approval Statement: The Institutional Review Board at Osaka Medical College approved the study protocol (No. 675(2476)) and waived the need for written, informed consent.
Highlights
Blood cultures are indispensable for detecting life-threatening bacteremia
Blood culture is an indispensable test for the detection of life-threatening bacteremia, a condition that is associated with high morbidity and mortality
We hypothesized that the mandatory use of alcohol/chlorhexidine gluconate (ACHX) before blood sampling may have changed the rate of blood culture contamination
Summary
Blood cultures are indispensable for detecting life-threatening bacteremia. Little is known about associations between contamination rates and topical disinfectants for blood collection in adults. We sought to determine whether a change in topical disinfectants was associated with the rates of contaminated blood cultures in the emergency department of a single institution. Topical alcohol/chlorhexidine gluconate (ACHX) reduces blood culture contamination more effectively than aqueous povidone-iodine (PVI)[6,7,8,9], most of the relevant studies were conducted in children; to our knowledge, definitive evidence on this topic had not been reported. At our institution, both agents have been routinely applied as topical disinfectants before blood sampling.
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