Blood Culture Contamination Rates Research Articles

Use of the Nonwire Central Line Hub to Reduce Blood Culture Contamination

The sterile conditions used when inserting a central venous catheter (CVC) might be thought to decrease the contamination rate of blood cultures taken at CVC insertion; however, a previous retrospective study showed the opposite, that such blood cultures are contaminated more frequently than peripheral venipuncture blood cultures. The current study explored whether use of the CVC nonwire hub as a source of blood cultures decreased contamination while maintaining detection of true pathogens. A prospective, observational study was performed from June 2010 to May 2011 in the general ICU of an academic, tertiary referral center. The proportions of blood cultures taken from wire and nonwire CVC hubs growing contaminants and true pathogens were compared. Risk factors for blood culture contamination were identified, and multivariate analysis was used to identify independent predictors of blood culture contamination. Among 313 blood cultures taken from 227 CVCs in 139 patients, 27 of 141 wire hub (19%) vs nine of 172 nonwire hub (5%) cultures were contaminated (P < .001). Only hub of blood culture origin was associated with contamination on multivariate analysis (OR, 4.3; 95% CI, 1.9-9.5; P < .001). True pathogens grew in 19 of 141 wire hub (13%) vs 27 of 172 nonwire hub (16%) cultures (P = .581). A higher proportion of blood cultures taken from the CVC lumen exposed to the guidewire were contaminated when compared with nonwire hub cultures; detection of true pathogens was equivalent. To limit detrimental sequelae of blood culture contamination, blood cultures obtained at CVC insertion should be taken from the nonwire hub.

Reducing Blood Culture Contamination Rates in the Emergency Department

Routine monthly monitoring of blood culture (BC) contamination rates detected a spike (>3%) in false-positive BCs drawn in the emergency department. This triggered an ad hoc quality-improvement team to develop and implement a corrective action plan in our 230-bed urban community hospital with 58,000 ED visits annually. Both phlebotomists and nurses draw BCs in the emergency department; therefore all interventions were directed at both groups. These included private conversations with individual staff members associated with higher numbers of contaminated draws compared with peers, ensuring availability of necessary BC collection supplies, re-education of all phlebotomists and ED nursing staff surrounding BC collection best practices, monthly feedback to staff on BC contamination rates, and continuing private conversations as necessary, regardless of the contamination rate. Before the spike in the emergency department, the average rate of BC contamination for the hospital as a whole was 1.82% (January-July 2011). Excluding 3 months when ED contamination was greater than 3% and the hospital contamination rate was 2.65% (August-October 2011), the average rate of BC contamination for the hospital dropped to 1.01% after the interventions (November 2011-June 2012). This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. The total hospital BC contamination rate never rose above the 3% benchmark, which illustrates the importance of tracking ED-specific data.

Blood Culture Contamination A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

To determine relative rates of blood culture contamination for 3 skin antisepsis interventions-10% povidone iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% chlorhexidine gluconate in 70% isopropyl alcohol (CHG)-when used by dedicated phlebotomy teams to obtain peripheral blood cultures. Randomized crossover trial with hospital floor as the unit of randomization. Teaching hospital with 885 beds. All adult patients undergoing peripheral blood culture collection on 3 medical-surgical floors from May 2009 through September 2009. Each antisepsis intervention was used for 5 months on each study floor, with random crossover after a 1-month washout period. Phlebotomy teams collected all peripheral blood cultures. Each positive blood culture was adjudicated by physicians blinded to the intervention and scored as a true positive or contaminated blood culture. The primary outcome was the rate of blood culture contamination for each antisepsis agent. In total, 12,904 peripheral blood culture sets were evaluated, of which 735 (5.7%) were positive. There were 98 contaminated cultures, representing 13.3% of all positive cultures. The overall blood culture contamination rate for the study population was 0.76%. Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics ([Formula: see text]), yielding 0.58% with PI (95% confidence interval [CI], 0.38%-0.86%), 0.76% with IT (95% CI, 0.52%-1.07%), and 0.93% with CHG (95% CI, 0.67%-1.27%). Choice of antiseptic agent does not impact contamination rates when blood cultures are obtained by a phlebotomy team and should, therefore, be based on costs or preference. ClinicalTrials.gov identifier: NCT01216761 .

Blood Culture Contamination A Clinical and Financial Burden

Affiliation: 1. Clinical Microbiology-Immunology Laboratories and Phlebotomy Services, University of North Carolina Hospitals, Chapel Hill, North Carolina; and University of North Carolina School of Medicine, Chapel Hill, North Carolina. Received September 20, 2012; accepted September 20, 2012; electronically published November 26, 2012. 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2013/3401-0003$15.00. DOI: 10.1086/668771 The study by Washer et al in this issue of the journal reminds us of the clinical and financial burden that contaminated blood cultures represent. Washer and colleagues ask a fairly simple question: of the 3 antiseptics most widely used to cleanse venipuncture sites prior to collection of blood for culture, which results in the lowest rate of contaminated blood cultures? The answer that none is superior is consistent with a recent Centers for Disease Control and Prevention (CDC) Laboratory Best Practices Guideline on practices that reduce blood culture contamination. Besides the finding that the type of antiseptic used does not influence blood culture contamination rates, 2 other practices are associated with reduced blood culture contamination rates: having blood cultures drawn by phlebotomists whose main duty is drawing blood and having blood drawn by venipuncture rather than from intravenous catheters are strongly associated with reduced rates of contamination. The finding that the type of disinfectant used does not influence the contamination rate may be at odds with the results of some previous studies, but the CDC’s systematic review of the data suggests otherwise. One of the key strengths of the study by Washer and colleagues is the use of a dedicated phlebotomy team. It is likely that training a small group of individuals to properly apply antiseptics with different dwell times contributes to the impressively low contamination rate of less than 1% regardless of antiseptic used. This rate is superior to that reported in many studies and is significantly below the American Society for Microbiology’s and College of American Pathologists’ benchmark for contaminated blood cultures, which is between 2.5% and 3%. Why are rates lower for phlebotomists than for other healthcare providers? Simply put, it is because of training, practice, resources, and professionalism. At our institution, phlebotomists routinely have a monthly blood culture contamination rate of less than 1%, as was seen in the study of Washer and colleagues. The training they receive includes one-on-one instruction by a senior phlebotomist during their initial series of blood culture collection and retraining if their individual contamination rates rise above 2%. This is not done with any other healthcare provider in a systematic manner in our institution. Phlebotomists draw the bulk of blood cultures obtained by venipuncture, so they are more practiced at this method. This is particularly key when drawing blood cultures from patients with poor venous access, who may require venipuncture of hand or foot veins, something that trained phlebotomists are comfortable doing, whereas many other healthcare providers are not. Phlebotomists also have all the supplies at hand on individual carts that travel with them, unlike other professionals, who may have to scrounge around for appropriate supplies. Finally, they take great pride in having contamination rates that are lower than those of any other professional who draws blood cultures at our institution. It is a benchmark of their worth to the institution, something of which they are well aware. Why is reducing blood culture contamination rates important? Simply put, contaminated blood cultures are expensive and put patients at risk for significant iatrogenic complications. The seminal work by Bates et al was the first to quantify the cost of a contaminated blood culture, at $4,500. This cost was due to increased length of stay, typically of 1 day; use of unnecessary antimicrobial therapy; and diagnostic testing. Subsequent studies have put this cost as high as $10,000. Let us use an illustration to understand the annual cost of contaminated blood cultures. Say that hospital A does 20,000 blood cultures annually and has a 2.5% contamination rate, while hospital B does 30,000 with a 1% contamination rate. The cost of a contaminated blood culture at each institution is $5,000. Hospital A, even though it does two-thirds the number of blood cultures, has an annual excess expense due to contaminated blood cultures of $2,500,000, while hospital B has a cost of $1,500,000. In addition, hospital A has 200 more hospital-days when a bed is not available compared with hospital B because of the increased length of stay of 1 day. In hospitals that have a chronic shortage of beds, those extra 200 hospital bed–days would be highly useful. The clinical impact of contaminated blood cultures is also

Reducing the Blood Culture Contamination Rate in a Pediatric Emergency Department and Subsequent Cost Savings

Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. A sterile blood culture collection process was designed by analyzing current practice and identifying areas in which sterile technique could be introduced. To spread the new technique, a web-based educational model was developed and disseminated. Subsequently, all nursing staff members were expected to perform peripheral blood cultures by using the modified sterile technique. The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period (P < .0001), with yearly estimated savings of ~$250,000 in hospital charges. Subsequent to our intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter.

P216: Blood culture contamination as an indicator of hand hygiene compliance

Hand hygiene (HH) monitoring by direct observation is the gold standard for compliance measure but is highly resource consuming. Indirect indicators could help to overcome resource constraints that are identified as a major obstacle to evaluate and feedback on HH practices. HH compliance may impact on blood culture contamination (BCC) rate.

Reducing Blood Culture Contamination in the Emergency Department: An Interrupted Time Series Quality Improvement Study

Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED. The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university-affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48-week baseline period (clean technique) and 48-week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first-order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%. During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period. A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.

Evaluación de la técnica LightCycler® SeptiFast en recién nacidos y lactantes con sospecha de sepsis

IntroductionNeonatal sepsis is a significant cause of morbidity and mortality. Early diagnosis and prompt antimicrobial therapy are crucial for a favorable outcome of the newborn child. Blood culture, the current “gold standard” method for diagnosing bloodstream infections, has a low sensitivity in newborns. We evaluated the multiplex real-time PCR LightCycler® SeptiFast (LC-SF) for detection of bloodstream infections in newborns, compared with conventional blood culture. MethodsA total of 42 blood samples were obtained from 35 subjects presenting with a febrile episode and hospitalized in neonatal intensive care unit at Hospital Universitario Virgen de las Nieves. Two samples were collected during each febrile episode in order to carry out LC-SF assay and blood culture, respectively. ResultsSensitivity and specificity of 79% and 87%, respectively, compared with clinical diagnosis, were obtained for LC-SF. Contamination rate of blood cultures was 16.7%, mainly due to coagulase-negative staphylococci (CoNS) and viridans groups of streptococci. Contamination rate of LC-SF by CoNS was 2.4%. Concordance between LC-SF and blood culture was moderate (kappa index: 0.369). LC-SF demonstrated a higher concordance (kappa index: 0.729) with the final clinical diagnosis than blood culture (kappa index: 0.238). ConclusionLC-SF assay could be a useful diagnostic tool, along with a conventional blood culture, in newborn, for confirming or ruling out those cases that blood culture could not determine, shortening the time to result to 7hours.

Laboratory Quality Control For All Can This Be Achieved?

Visiting hospitals in Africa and meeting with clinicians, pathologists, and laboratory directors, it rapidly becomes apparent that confidence in any diagnostic services is lacking. Clinicians cite many reasons. Some days complete blood cell counts and chemistries are available, while on other days, because there are no reagents available, physicians have no results to guide treatment for their patients. Blood cultures, when available, are frequently contaminated by fungi and bacteria and you cannot be sure if the organism identified is the cause of the patient's fever. Turnaround times are incredibly long, and by the time a result is available, it is too late to be clinically relevant. Consequently, clinicians continue to practice medicine using a syndromic approach rather than defining a specific diagnosis. Unfortunately, this happens routinely, even in large African academic centers and in much of the developing world. One of the things that clinicians in developed countries take for granted are efficient laboratories that deliver credible results. For example, clinicians order blood work as the patient is leaving their office, and the results appear in the electronic medical record that afternoon. They get a call from the laboratory when budding yeasts show up in a blood culture obtained 2 days ago in a patient with a transplant who had been admitted with fever and treat the patient accordingly; they know blood culture contamination rates in the hospital are low and are confident that there is little likelihood that these yeasts are a contaminant. Two days after a patient with a gastric ulcer undergoes an endoscopic biopsy, a pathologist's report shows adenocarcinoma, and thus staging and treatment can be started. Having reagents daily in the laboratory and working with well-maintained instruments allow for dependable turnaround times. Using internal and external quality controls is indispensable for consistency of laboratory results. These …

Strategies on reducing blood culture contamination

Blood culture contamination (BCC) is a common problem in hospitals; contaminated or false-positive blood cultures may confuse the clinicians, precipitate unnecessary antibiotics usage as well as prolonging the hospital stay for patients. Although it is not possible to eliminate BCC, it is important that we introduce methods to reduce BCC. These methods include changes to the sampling technique to increase the chance of sterility, selection of appropriate skin prep kits, using a trained phlebotomy team rather than junior doctors, and introducing an interactive approach, along with clinical clues and laboratory tests for the classification of blood culture results to minimize BCC rate.

Effective strategy for decreasing blood culture contamination rates: the experience of a veterans affairs medical centre

Contaminated blood cultures constitute diagnostic challenges and place a burden on healthcare services. An observational retrospective study was undertaken to evaluate the effect of routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, on blood culture contamination rates. The contamination rate of the entire facility was 2.6% before the procedural change, and this decreased significantly to 1.5% after the procedural change (P<0.001) over the first 12 months of the intervention. Routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, was effective in reducing blood culture contamination rates.

Practical Steps to Lower Blood Culture Contamination Rates in the Emergency Department

Blood culture testing is routinely used to diagnose infections in symptomatic patients admitted to the emergency department. Blood cultures are necessary for accurate identification of pathogens and to provide targeted antibiotic therapy. Unfortunately, contamination of blood cultures from microorganisms outside the bloodstream is common, resulting in delayed or imprecise treatment, increased risks of morbidity, extended hospital stays, and increased costs of care. 1 Hall KK Lyman JA Updated review of blood culture contamination. Clin Microbiol Rev. 2006; 19: 788-802 Crossref PubMed Scopus (495) Google Scholar , 2 Weinstein MP Blood culture contamination: persisting problems and partial progress. J Clin Microbiol. 2003; 41: 2275-2278 Crossref PubMed Scopus (273) Google Scholar , 3 Ernst DJ Controlling blood-culture contamination rates. MLO Med Lab Obs. 2004; 36: 14-18 PubMed Google Scholar Jennifer Denno, Member, Sacramento Chapter, is Clinical Nurse Educator, Emergency Department, Sutter Medical Center, Sacramento, CA. Mary Gannon, Member, Sacramento Chapter, is Staff Nurse, Emergency Department, Sutter Medical Center, Sacramento, CA.

Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis

This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits. The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12). Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement.

Reducing Blood Culture Contamination in the Emergency Department

Our hospital's Emergency Department had a blood culture contamination rate ranging from 2-4 times the national average. Contaminated blood cultures lead to increased length of stay, increase cost and unnecessary antibiotic use with the associated problems of pressure toward antimicrobial resistance and increased risk of C. difficile associated disease.

A Process Improvement Project Decreases Blood Culture Contamination Rates in the Emergency Room

Ob-Gyn hospital. Evaluate safe effectiveness and reduction of risk in surgery after 2 month SSC application. Methods: Gather comments from560 doctors and nurses related to the process of preparing the surgical patients and surgeries. Summarize all the surgical complication in total 3.102 surgical cases, conducted during 2 month application of the SSC. Results: All comments supported the necessity of the SSC application: 95.15% comments found the SSC appropriate and applicable, while the other 4.85% found it complicated and time-consuming. Suggestion to add information of neonatal doctor, midwife with full neonatal intensive care equipments into B item and checking the number of mother to match with the number of newborn before bringing the newborn out of operating room into C item. There was only one case with severe bleeding at pre-operation and during operation, leading to coagulation disorder. This complication made the patient hospitalize for post-operative 20 days. It was an emergency operation as the admission was severe bleeding central placenta previa. No post-operative infection cases found. Conclusions: The SSC was highly effective and necessary. It should be applied for all surgical cases. However, there should be some minor modifications as stated above to make it more suitable with local culture and characteristics of an ObGyn hospital.

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

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.

Blood cultures

British Journal of Hospital MedicineVol. 73, No. 4 Tips From The Shop FloorBlood culturesSusan DawsonSusan DawsonSearch for more papers by this authorSusan DawsonPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2012.73.sup4.C53AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alahmadi YM, Aldeyab MA, McElnay JC et al. (2011) Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 77: 233–6 Crossref, Medline, Google ScholarBennett IL, Beeson PB (1954) Bacteremia: a consideration of some experimental and clinical aspects. Yale J Biol Med 26: 241–62 Medline, Google ScholarCaldeira D, David C, Sampaio C (2011) Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. J Hosp Infect 77: 223–32 Crossref, Medline, Google ScholarDark PM, Dean P, Warhurst G (2009) Bench-to-bedside review: The promise of rapid infection diagnosis during sepsis using polymerase chain reaction-based pathogen detection. Crit Care 13: 217 Crossref, Medline, Google ScholarDepartment of Health (2007) Taking Blood Cultures A summary of best practice. Department of Health, London Google ScholarDepartment of Health (2010) Taking Blood Cultures A summary of best practice. http://hcai.dh.gov.uk/files/2011/03/Document_Blood_culture_FINAL_100826.pdf (accessed 12 March 2012) Google ScholarDwivedi S, Bhalla R, Hoover DR, Weinstein MP (2009) Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol 47(9): 2950–1 Crossref, Medline, Google ScholarGeneral Medical Council (2009) Tomorrow's Doctors Outcomes and standards for undergraduate medical education. General Medical Council, London Google ScholarGould FK, Denning DW, Elliott TSJ et al. (2012) Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrobl Chemother 67(2): 269–89 Crossref, Medline, Google ScholarHall KK, Lyman JA (2006) Updated review of blood culture contamination. Clin Microbiol Rev 19(4): 788–802 Crossref, Medline, Google ScholarJumaa PA, Chattopadhyay B (1994) Pseudobacteraemia. J Hosp Infect 27: 167–77 Crossref, Medline, Google ScholarLarkin S, Baker N, Anderson R, Ward S, Forde S (2010) An interactive approach to reducing blood culture contamination. J Hosp Infect 76: 273–5 Crossref, Medline, Google ScholarMermel LA, Allon M, Bonza E et al. (2009) Clinical Practice Guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49: 1–45 Crossref, Medline, Google ScholarMylotte Jm, Tayara A (2000) Blood Cultures: Clinical aspects and controversies. Eur J Clin Microbiol Infect Dis 19: 157–63 Crossref, Medline, Google ScholarReidel S, Bourbeau P, Swartz B et al. (2008) Timing of specimen collection for blood cultures from febrile patients with bacteraemia. J Clin Microbiol 46(4): 1381–5 Crossref, Medline, Google ScholarSchifman RB, Strand CL, Meier FA, Howanitz PJ (1998) Blood culture contamination: A College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 122: 216–21 Medline, Google ScholarShore A, Sandoe J (2008) Blood cultures. Student BMJ 16: 324–5 Google ScholarSpitalnic SJ, Woolard RH, Mermel LA (1995) The significance of changing needles when inoculating blood cultures: a meta-analysis. Clin Infect Dis 21: 1103–6 Crossref, Medline, Google ScholarThomas S, Cheesbrough J, Plumb S et al. (2011) Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences. J Hosp Infect 78: 256–9 Crossref, Medline, Google ScholarThompson F, Madeo M (2009) Blood cultures: towards zero false positives. J Infect Prevent 10(1): s24–26 Crossref, Google ScholarWeinstein MP (2003) Blood Culture Contamination: Persisting Problems and Partial Progress. J Clin Microbiol 41(6): 2275–8 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byImpact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of laboratory medicineJournal of Patient Safety and Infection Control, Vol. 7, No. 3 1 April 2012Volume 73Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 April 2012 Information© MA Healthcare LimitedPDF download

Dimethyl Sulfoxide Enhances Effectiveness of Skin Antiseptics and Reduces Contamination Rates of Blood Cultures

Effective skin antisepsis is of central importance in the prevention of wound infections, colonization of medical devices, and nosocomial transmission of microorganisms. Current antiseptics have a suboptimal efficacy resulting in substantial infectious morbidity, mortality, and increased health care costs. Here, we introduce an in vitro method for antiseptic testing and a novel alcohol-based antiseptic containing 4 to 5% of the polar aprotic solvent dimethyl sulfoxide (DMSO). The DMSO-containing antiseptic resulted in a 1- to 2-log enhanced killing of Staphylococcus epidermidis and other microbes in vitro compared to the same antiseptic without DMSO. In a prospective clinical validation, blood culture contamination rates were reduced from 3.04% for 70% isopropanol-1% iodine (control antiseptic) to 1.04% for 70% isopropanol-1% iodine-5% DMSO (P < 0.01). Our results predict that improved skin antisepsis is possible using new formulations of antiseptics containing strongly polarized but nonionizing (polar aprotic) solvents.

Steps to lowering blood culture contamination rates in the ED

Steps to lowering blood culture contamination rates in the ED

The impact of overcrowding on the bacterial contamination of blood cultures in the ED

ObjectivesThis study aims to determine the risk factors associated with the bacterial contamination of blood cultures among adults visiting the emergency department (ED). MethodsClinical variables and medical records of adults with bacterial growth of blood cultures in the ED as well as the degree of ED crowding, between August 2007 and July 2008, were prospectively collected. ResultsOf the 11 491 adults who underwent blood culture sampling, the medical records of 558 (4.86%) eligible patients with bacterial growth in their blood cultures were analyzed. Most patients (366, or 3.19%) had true bacteremia, whereas 192 (1.67%) were regarded as contaminated. In multivariate analyses, ED overcrowding (scoring was based on a National Emergency Department Overcrowding Study [NEDOCS] score ≥100 points) was independently associated with blood culture contamination (odds ratio [OR], 1.58; P = .04). In contrast, other medical comorbidities, such as liver cirrhosis (OR, 0.31; P = .02), thrombocytopenia (<100 000/mm3; OR, 0.28; P = .002), or high serum levels of C-reactive protein (>100 mg/L; OR, 0.24; P < .001), were negatively associated with blood culture contamination. On further analysis of the 5 crowding categories as stratified by NEDOCS scores, which included not busy and busy (0-60 points), extremely busy but not overcrowded (60-100), overcrowded (100-140), severely overcrowded (140-180), and dangerously overcrowded (180-200), there was a strong correlation between blood culture contamination rates and the degrees of ED crowding (γ = 0.99, P < .001). ConclusionsEmergency department overcrowding may have an adverse impact on the quality of clinical care, including increasing the risk of blood culture contamination.