Role of Hand Hygiene and Sterile Blood Sampling in Reduction of False Positive Blood Cultures from a Neonatal Intensive Care Unit of a Rural Teaching Hospital: A Quasi-experimental Study

Abstract

Introduction: Blood culture remains the gold standard for diagnosis of newborn infections. Its contamination not only results in inadvertent use of antimicrobials against the false positives but also causes substantial financial burden and patient safety concerns. There are various ways to reduce blood contamination, of which hand hygiene and sterile blood sampling are most crucial. Aim: To evaluate and reduce the blood contamination rate and false positive blood cultures from the Neonatal Intensive Care Unit (NICU). Materials and Methods: The prevalent bacteriology and Blood Culture Contamination Rate (BCCR) at the NICU was assessed by a retrospective study on all the neonates with suspected sepsis who had blood culture at admission. Healthcare workers at NICU were observed for their hand wash and sterile blood sampling technique by dedicated team members. Identified deficiencies among them were intervened by an educational model with regular training and reinforcement on hygienic practices for three months. Postintervention prospective study was done on all the neonates with suspected sepsis who had blood culture at admission. During this period the same educational model continued, to know its efficacy in reduction of blood contamination and change of bacteriology pattern. Data collected was entered into Microsoft excel sheet 2010 version and analysed using software Stata 14.0 version. Results: Preintervention blood culture reports of 205 neonates screened for sepsis showed 58 (28.3%) samples with positive growth. Of this, 18 were contaminants, 31 were Coagulase Negative Staphylococci (CoNS), three gram negative and six gram positive organisms with blood contamination rate of 8.7%. Blood culture reports of postintervention study on 200 neonates screened for sepsis showed 41 (20.5%) samples positive for growth. Bacteriology showed 12 contaminants, 13 CoNS, eight gram positives, seven gram negatives and one fungal growth with BCCR of 6%. After intervention growth of CoNS was reduced which was statistically significant (p<0.05). Conclusion: Simple inexpensive education programme helps the healthcare workers to follow the standard technique of hand wash and sterile blood sampling which goes a long way in reducing blood culture contamination.