Significant Reduction of Blood Culture Contamination in the Emergency Department (ED) Using the Steripath® Blood Diversion Device

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BackgroundContaminated blood cultures are a particular problem in EDs and often lead to unnecessary antibiotic treatment. A potential approach to reduce contamination is to discard the initial aliquot of blood which is often contaminated with skin plugs and bacteria. To test this approach, we performed a study using the Steripath® (SP) device (Magnolia Medical Technologies, WA) a pre-assembled, sterile blood culture system designed to divert the initial 1.5–2.0 mls of blood prior to bottle inoculation.MethodsThis was a pre-post intervention study conducted in the ED at Rush University Medical Center, Chicago. During the pre-intervention phase (1 September to 30 November 2015), 2 sets of peripheral blood cultures were collected using standard aseptic technique by nurses in the ED. Skin antisepsis was performed with ChloraPrep® and 5–10 mls of blood was inoculated into BacT Alert SA and SN bottles (Biomerieux). During the intervention phase (1 February to 1 May 2016), blood cultures were collected using the SP device. All bottles were incubated for 5 days and rates of blood culture contamination were compared between control and intervention periods.ResultsClassification of blood culture contamination was based on standard CLSI criteria. During the control phase, 929 sets of blood cultures were collected in the ED. A total of 40/929 sets (4.3%) from 36 patients were identified as contaminations and 81 sets (8.7%) from 51 patients were identified as true bacteremia. The contaminants included: 29 sets (72.5%) coagulase negative Staphylococcus spp. (CoNS), 4 sets (10%) Micrococcus spp., 3 sets (7.5%) Corynebacterium spp., 2 sets (5%) alpha-hemolytic Streptococci spp., 1 set (2.5%) each Bacillus spp. and E. faecium. During the intervention phase, 3/539 (0.6%) sets of blood cultures from 3 patients were contaminated (P < 0.001). The 3 contaminants were 1 CoNS, 1 alpha-hemolytic Streptococcus spp. and 1 Corynebacterium spp. 49 sets (9.1%) from 35 patients were identified as true bacteremia.ConclusionThe use of the SP device in the ED over a 3-month period significantly reduced the rate of blood culture contamination from 4.3% to 0.6% while the rates of true bacteremia remain unchanged. The SP device represents a simple and effective method for reducing blood culture contaminationDisclosures All authors: No reported disclosures.