Blood Culture Contamination Research Articles

Improving awareness of blood culture indication, procedure and resource Utilization at Armed Forces Hospital Jizan, Saudi Arabia

Blood culture contamination (BCC) is a significant quality and safety issue in hospitals, as it leads to increase in unnecessary testing, admissions, antibiotic exposure and cost. This study is the...

Effect of Wearing Personal Protective Equipment (PPE) for COVID-19 Treatment on Blood Culture Contamination: Implication for Optimal PPE Strategies.

The personal protective equipment (PPE) used to minimize exposure to hazards can hinder healthcare workers from performing sophisticated procedures. We retrospectively reviewed 77,535 blood cultures (202,012 pairs) performed in 28,502 patients from January 2020 to April 2022. The contamination rate of all blood cultures was significantly elevated in the coronavirus disease 2019 ward at 4.68%, compared to intensive care units at 2.56%, emergency rooms at 1.13%, hematology wards at 1.08%, and general wards at 1.07% (All of P < 0.001). This finding implies that wearing PPE might interfere with adherence to the aseptic technique. Therefore, a new PPE policy is needed that considers the balance between protecting healthcare workers and medical practices.

Evaluation of blood culture samples for contamination and assessment of possible causes

Blood is an enriched growth medium for the growth of microorganisms. Blood culture is the key test for diagnosis of bacteremia and fungemia in patients. A false positive blood culture (blood culture contaminants) is a challenge for both consultants and microbiologists as well. This study based on highlighting source of blood culture contamination and ways of prevention in laboratory and hospitals.

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line-associated bloodstream infections.

To assess the impact of initial specimen diversion device (ISDD) on inpatient and emergency department blood culture contamination (BCC), central-line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs), and antibiotic administration. Single-center quasi-experimental prospective cohort study wherein phlebotomists used traditional venipuncture with or without the ISDD while registered nurses (RNs) used traditional venipuncture. BCC events among phlebotomists and RNs were observed and compared from March 17, 2019, through January 21, 2020, defined by contaminant detection in 1 of 4 bottles for matched sets or 1 of 2 bottles in both subsets for coagulase negative staphylococci. CLABSIs throughout this period were recorded and SIRs were calculated. Enhanced oversight took place through July 21, 2019, with chart review assessing antibiotic use for patients with possible BCC. Overall, 24% of blood cultures obtained were from patients in intensive care. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate; phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs drew 7,411 BCs with a 0.8% BCC rate. The CLABSI SIR was decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019. The CLABSI incidence was 33%-64% of predicted value for each 2019 quarter. This range fell to 18%-37% after the exclusion of likely false-positive results. Among 42 patients with possible BCC under enhanced oversight, 2 patients were treated with prolonged antibiotic courses. ISDD use by phlebotomists was associated with BCC reduction and reduced false-positive CLABSI results. This patient-care quality improvement could constitute sustainable antibiotic stewardship expansion.

Monocyte distribution width (MDW) as a useful indicator for early screening of sepsis and discriminating false positive blood cultures.

Severe sepsis and septic shock are the leading cause of in-hospital death. As sepsis progresses, expression and activity of endogenous mediators of inflammation change. Early detection of biomarkers can play a role in sepsis screening and in improvement of patient outcomes. Recent studies suggest that increase in monocyte volume may be helpful in early detection of sepsis. Therefore, we evaluated the utility of monocyte distribution width (MDW) for the early assessment of sepsis compared with the blood culture and other inflammatory biomarkers. Medical records of 1,404 patients (aged ≥19 years) who were admitted to the emergency department owing to clinically suspected infectious disease and requested blood cultures from Oct 2019 to Jan 2021 were reviewed. The patients were grouped based on Sepsis-3 criteria. They had undergone other laboratory tests to evaluate their clinical status. MDW was analyzed using DxH900 hematology analyzer (Beckman Coulter, Brea, California, USA). To determine the diagnostic performance of MDW, C-reactive protein (CRP), and procalcitonin (PCT) for sepsis, the area under the curve (AUC) of receiver operating characteristics curves and their sensitivity and specificity were measured. Among 1,404 patients, 520 patients were designated the sepsis group based on Sepsis-3 criteria. In the sepsis group, MDW value was 24.1 (median, IQR 21.6-28.1); AUC values for MDW, CRP, and PCT were 0.67 (95% CI, 0.64-0.69), 0.66 (95% CI, 0.63-0.68), and 0.75 (95% CI, 0.72-0.77), respectively. For diagnosis of the sepsis, the cut-off value of MDW was 21.7 (sensitivity 74% and specificity 54%). Measured values of MDW were higher for the blood culture positive group than that of the blood culture contamination group (P<0.001, 95% CI, -5.9 to -3.0) or blood culture negative group (P<0.001, 95% CI = -5.8 to -4.2). MDW is a new hematological parameter that is simultaneously calculated during complete blood cell counting by Beckman Coulter hematology analyzer. MDW is expected to serve as a useful indicator for early screening of sepsis in conjunction with CRP and PCT. MDW is especially useful for sepsis assessment in patients with a suspected infection. MDW can also assist in discriminating false positive blood cultures.

193. Rapid Diagnostic Testing and Vancomycin Utilization for Contaminated Blood Cultures

Abstract Background Bacteremia is a prevalent hospital acquired infection that affects nearly one in ten hospitalized patients. Rates of contaminated blood cultures have ranged from 0.6% to 6% in the literature. Vancomycin is often chosen as empiric coverage for gram positive organisms while awaiting bacterial identification. The purpose of this study was to evaluate the impact of GenMark ePlex Blood Culture Identification Panel (BCID) implementation on the duration of vancomycin therapy for blood cultures contaminated with coagulase negative staphylococci (CoNS). Methods A retrospective chart review was conducted on patients meeting inclusion criteria during a six month period prior to BCID implementation and post BCID implementation, from 03/01/2019 to 08/31/2019 and 03/01/2021 to 08/31/2021. The primary outcome analyzed was the duration of vancomycin therapy, in hours, in patients with a contaminated blood culture. Contaminated blood cultures was defined as a single blood culture growing CoNS. Secondary outcomes included hospital length of stay, readmission for treatment of contaminated blood cultures, and nephrotoxicity. Results This IRB-approved study included 190 patients, 75 in the pre-BCID group and 115 in the post-BCID group. The average duration of vancomycin therapy was 53.7 hours in the pre-BCID group and 20.5 hours in the post-BCID group (p = 0.04). Time to organism identification was reduced from 22.8 hours in the pre-BCID group to 12 hours in the post-BCID group (p = 0.5). Additionally, our study did not find a difference in nephrotoxicity, hospital length of stay, or readmissions between the two groups. Conclusion Following implementation of the GenMark ePlex Blood Culture Identification Panel (BCID), there was a reduction in both duration of vancomycin therapy and time to culture identification for blood cultures contaminated with CoNS. Rapid diagnostic testing is helpful in clinical decision-making and can lead to earlier discontinuation of empiric antibiotics, such as vancomycin. Disclosures All Authors: No reported disclosures.

188. Opportunities for antimicrobial stewardship: Time to optimal therapy and vancomycin use in gram-positive and contaminated blood cultures before and after implementation of rapid blood culture diagnostic testing

Abstract Background Rapid molecular diagnostic tests improve time to organism identification and may expedite antimicrobial de-escalation. Through faster detection of contaminated samples, rapid blood culture identification (BCID) should also reduce unnecessary antibiotic use. BioFire FilmArray BCID was implemented in July 2019 at a community hospital. This study compared antimicrobial use for gram-positive blood cultures before and after BCID implementation to identify areas for further antimicrobial stewardship intervention. Methods This retrospective cohort study evaluated adult patients at a 450-bed community hospital with gram-positive blood culture results between February and June 2018 and 2019 (pre-and post-BCID). Patients were excluded for polymicrobial bacteremia, pregnancy, or expiration/hospice status before blood culture positivity. The primary outcome was time to optimal therapy (TTOT) for bacteremia, defined as time to antimicrobial de-escalation, discontinuation, or result for untreated contaminated cultures. Time to organism identification, receipt of optimal therapy, and vancomycin duration were also evaluated, in addition to subgroup analysis of contaminated cultures (identified by microbiology comment or physician note). Results Of the 232 patients, median age was 70 years and 54.3% were male. Coagulase-negative staphylococci was most commonly isolated (n=104, 45%) and contamination rate was 53.4%. Median TTOT improved from 53.3 vs 28 hours, p&amp;lt; 0.001 in pre- vs post-groups, respectively, and optimal therapy selection increased from 83% to 93%, p=0.028. Median time to organism identification was 60.2 vs 23.5 hours, p&amp;lt; 0.001. Median duration for vancomycin (35.1 vs 25.2 hours, p=0.231) and overall antimicrobial duration did not differ between groups. Among contaminated blood cultures, TTOT improved (54 vs 27.3 hours, p&amp;lt; 0.001) and vancomycin median duration decreased (27.5 vs 16.6 hours, p=0.253). Conclusion Rapid BCID significantly improved TTOT, resulting in improved rates of optimal therapy and an observed reduced vancomycin duration. High rates of contaminated blood cultures identified opportunities for coordination with antimicrobial stewardship to reduce contamination rates and improve antimicrobial use. Disclosures All Authors: No reported disclosures.

1518. Bacteremia due to Non-Staphylococcus aureus Gram-positive Cocci and Risk of Cardiovascular Implantable Devices Infection

Abstract Background Cardiovascular implantable electronic devices (CIED) infection carries significant morbidity, mortality, and financial burden. Bacteremia in patients with CIED increases risk of CIED infection. While several investigations have examined Staphylococcus aureus bacteremia and risk of CIED infection, data regarding non-S. aureus gram-positive coccal (non-SA GPC) bacteremia in patients with CIED has been both limited and dated. The current study examined the clinical characteristics of patients with CIED who developed non-SA GPC bacteremia and their proclivity of CIED infection. Methods We reviewed all patients with CIED who developed non-SA GPC bacteremia at Mayo Clinic between 2012–2019. Cases with a left ventricular assist device, non-hospitalization, and contaminated blood culture were excluded. The 2019 European Heart Rhythm Association International Consensus Document was used to define CIED infection. Results A total of 160 patients with CIED developed non-SA GPC bacteremia during the period. Ninety (56.2%) patients had CIED infection, with 60 (37.5%) classified as definite and 30 (18.8%) possible. This included 41/64 (64.1%) patients with coagulase-negative Staphylococcus (CoNS), 30/41 (73.2%) patients with Enterococcus, 13/19 (68.4%) patients with viridans group streptococci (VGS), and 6/36 (16.6%) patients with other non-SA GPC. The odds of CIED infection (with 95% CI) for CoNS, Enterococcus, and VGS bacteremia were 8.9 (3.2–24.6), 13.6 (4.5–41.6), and 10.8 (2.9–40.0) -fold higher, respectively, as compared to other non-SA GPC. Among those with infected CIED, 51 (56.7%) patients underwent complete device extraction after a median of 6 (IQR 3.5–10) days. In an unadjusted analysis of patients with CIED infection, the reduction in one-year mortality following device removal was not statistically significant (HR 0.59, 95% CI 0.26–1.33, p=0.198). Conclusion The overall prevalence of CIED infection following non-SA GPC bacteremia was higher than previously reported, particularly that due to CoNS, Enterococcus, and VGS. Further study with a larger cohort is needed to demonstrate the survival benefit from CIED extraction in patients with infected CIED due to non-SA GPC. Disclosures Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties Rizwan Sohail, M.D., Aziyo Biologics: Advisor/Consultant|Boston Scientific: Advisor/Consultant|Medtronic: Advisor/Consultant|Philips: Advisor/Consultant|Philips: Honoraria Malini Madhavan, M.B.B.S., Biosense Webster: Advisor/Consultant|Biotronik Inc: Advisor/Consultant|Boston Scientific: Grant/Research Support|Convatec: Advisor/Consultant.

2018. Comparison of Trends in Hospital-Onset Bloodstream Infections (HOBSIs) and Central Line Associated Bloodstream Infections (CLABSIs) across a Three-Hospital Health System in the COVID Era

Abstract Background Hospital-onset bloodstream infection (HOBSI) incidence has been proposed as a complementary quality metric to central line-associated bloodstream infection (CLABSI) surveillance. Several recent studies have detailed increases in median HOBSI and CLABSI rates during the COVID-19 pandemic. We sought to understand trends in HOBSI and CLABSI rates at a single health system in the context of COVID-19. Methods We conducted a retrospective analysis of HOBSIs and CLABSIs at a three-hospital health system from 2017 to 2021 (Figure 1). We compared counts, denominators, and demographic data for HOBSIs and CLABSIs between the pre-pandemic (1/1/2017-3/30/2020) and pandemic period (4/1/2020-12/31/2021) (Table 1). We applied Poisson or negative binomial regression models to estimate the monthly change in incidence of HO-BSI and CLABSI rates over the study period. Figure 1:Definitions applied for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs). Potentially contaminated blood cultures were identified by microbiology laboratory technicians as any set of blood culture in which a single bottle was positive for organisms typically considered as skin contaminants. Uncertain cases undergo secondary review by senior lab technicians. Table 1:Count, denominator, and device utilization ratio data for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs)Note that central line utilization increased upon regression analysis (p&amp;lt;0.001). Results The median monthly HOBSI rate per 1,000 patient days increased from 1.0 in the pre-pandemic to 1.3 (p&amp;lt; 0.01) in the pandemic period, whereas the median monthly CLABSI rate per central line days was stable (1.01 to 0.88; p=0.1; Table 2). Our regression analysis found that monthly rates of HO-BSIs increased throughout the study, but the increase was not associated with the onset of the COVID-19 pandemic based on comparisons of model fit (Figure 2; Table 3). Despite an increase in central line utilization, regression modelling found no changes in monthly CLABSIs rates with respect to time and the COVID-19 pandemic. Incidence of HOBSIs and CLABSIs by common nosocomial organisms generally increased over this time period, though time to infection onset remained unchanged in our studied population (Table 2). Table 2:Epidemiology and demographic characteristics of hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs).Figure 2:Regression analysis of monthly rates of HO-BSIs and CLABSIs over time per patient days (left) and CLABSIs per central line days (right). Gray areas denote COVID-19 pandemic period (April 2020 to December 2021). Provided p values refer to the statistical significance of the coefficient of the time variable in each model. Table 3:Likelihood ratio tests comparing regression models.No statistical significance was noted between models that included COVID-19 variables (including a time-trended post-pandemic variable) and models that were only time-dependent. Conclusion HOBSIs rates did not correlate with CLABSI incidence across a three-hospital health system from 2017 and 2021, as rates of HOBSI increased but CLABSI rates remained flat. Our observed increase in HOBSI rates did not correlate with the onset of the COVID-19 pandemic, and caution should be used in modeling the effects of COVID-19 without time-trended analysis. Further evaluation is needed to understand the etiology, epidemiology, and preventability of HO-BSI. Disclosures All Authors: No reported disclosures.

Benchmarking taxonomic classifiers with Illumina and Nanopore sequence data for clinical metagenomic diagnostic applications.

Culture-independent metagenomic detection of microbial species has the potential to provide rapid and precise real-time diagnostic results. However, it is potentially limited by sequencing and taxonomic classification errors. We use simulated and real-world data to benchmark rates of species misclassification using 100 reference genomes for each of the ten common bloodstream pathogens and six frequent blood-culture contaminants (n=1568, only 68 genomes were available for Micrococcus luteus). Simulating both with and without sequencing error for both the Illumina and Oxford Nanopore platforms, we evaluated commonly used classification tools including Kraken2, Bracken and Centrifuge, utilizing mini (8 GB) and standard (30-50 GB) databases. Bracken with the standard database performed best, the median percentage of reads across both sequencing platforms identified correctly to the species level was 97.8% (IQR 92.7:99.0) [range 5:100]. For Kraken2 with a mini database, a commonly used combination, median species-level identification was 86.4% (IQR 50.5:93.7) [range 4.3:100]. Classification performance varied by species, with Escherichia coli being more challenging to classify correctly (probability of reads being assigned to the correct species: 56.1-96.0%, varying by tool used). Human read misclassification was negligible. By filtering out shorter Nanopore reads we found performance similar or superior to Illumina sequencing, despite higher sequencing error rates. Misclassification was more common when the misclassified species had a higher average nucleotide identity to the true species. Our findings highlight taxonomic misclassification of sequencing data occurs and varies by sequencing and analysis workflow. To account for 'bioinformatic contamination' we present a contamination catalogue that can be used in metagenomic pipelines to ensure accurate results that can support clinical decision making.

Higher nursing care level is associated with higher incidence of blood culture contamination in the emergency department: A case-control study.

Blood culture is critical in treating infectious diseases. This leads to unnecessary intervention, inappropriate antibiotic use, and excess cost. Few studies have tackled patient factors that could possibly affect contamination rates. This study aimed to explore the association between patients' nursing care levels and blood culture contamination. This is a single-centered, retrospective, case-control study of adult patients whose blood culture specimens were taken in the emergency department between April 2018 and July 2019. The study was conducted in an acute care community hospital in Japan. The case group included patients with false-positive blood culture results with contamination; the control group included patients with true-positive or true-negative blood culture results without contamination. We randomly selected two control patients per case. Patients' age, gender, nursing care level, ambulance use, housing status, Glasgow Coma Scale, hospital arrival time, and puncture sites were obtained from the patients' medical charts. Of the 5130 patients, 686 patients got positive blood culture results. Of the 686 patients, 35 patients were included in the case group, and 70 were randomly selected from the noncontaminated group and included in the control. In multivariate analysis, patients with contaminated blood cultures had a higher nursing care level (adjusted odds ratio: 8.50; 95% confidence interval: 1.65-43.7; p=0.01). A higher nursing care level is associated with a higher incidence of blood culture contamination in the emergency department. Careful and appropriate procedures are required for patients with a higher nursing care level.

Effect of Blood Culture Contamination on Antibiotic Use in an Institution With Rapid Laboratory Methods and Phone-Based Clinical Follow-up of Blood Culture Results.

In a multivariate analysis of 30 574 blood culture (BC) results, BC contamination was associated with only a small increase in antibiotic length of therapy compared to no-growth BCs (difference, 0.36 days [95% confidence interval, .05-.67]; P = .02). Stewardship processes at our institution appear to be effective in reducing the impact of BC contamination.

Time to decision in sepsis.

This study aimed to identify the common barriers leading to delayed initial management, microbiological diagnosis, and appropriate empirical antimicrobial treatment in sepsis. A cross-sectional study was performed by the application of a population-based survey. Four different surveys were designed, targeting the healthcare personnel located in main hospital areas [emergency department (SEMES); infectious diseases and clinical microbiology-microbiological diagnosis (SEIMC-M); intensive care and infectious diseases, (SEMICYUC-GTEIS); and infectious diseases and clinical microbiology-clinical diagnosis, (SEIMC-C)]. A total of 700 valid surveys were collected from June to November 2019: 380 (54.3%) of SEMES, 127 (18.1%) of SEIMC-M, 97 (13.9%) de SEMICYUC-GTEIS and 96 (13.7%) of SEIMC-C, in 270 hospitals of all levels of care. The qSOFA score was used as a screening tool. The most used biomarker was procalcitonin (n=92, 39.8%). The sepsis code was implemented in 157 of 235 participating centers (66.2%), particularly in tertiary level hospitals. The mean frequency of contaminated blood cultures was 8.9% (8.7). In 85 (78.7%) centers, positive results of blood cultures were available within the first 72 hours and were communicated to the treating physician effectively by phone or e-mail in 76 (81.7%) cases. The main reason for escalating treatment was clinical deterioration, and the reason for de-escalating antimicrobials was significantly different between the specialties. Quality indicators were not frequently monitored among the different participating centers. There are significant barriers that hinder adequate management processes in sepsis in Spanish hospitals.

Clean the skin: Reducing blood culture contamination in the emergency department.

To determine whether blood culture contamination (BCC) rates could be decreased in the ED by an educational programme. Educational intervention focusing on a 1-min venepuncture cleaning time and providing a larger chlorhexidine alcohol swab. BCC rates were examined retrospectively 12-month pre-, and 9-month post-intervention. Six thousand nine hundred and fifty-three blood cultures were collected over the study period. The BCC rate was 2.4% pre-intervention versus 1.8% post-intervention, with no significant difference in BCC rates (Z-score=1.862, P=0.063). This educational intervention focusing on skin clean time did not significantly decrease BCC rates in a setting of an already low (<3%) BCC rate.

Weighing the odds of bloodstream infection. What is the perfect model to predict this risk?

Bloodstream infection (BSI) is a leading cause of morbidity and mortality worldwide [1]. Timely diagnosis of BSI is essential to improve clinical and antimicrobial management [2]. The consequences of missing a BSI diagnosis are grave given the high risk of complications. On the other hand, obtaining unnecessary blood cultures increases the cost of healthcare. Occasional growth of skin contaminants in blood cultures and the physiologic phenomenon of transient bacteraemia caused by viridans group streptococci may often complicate clinical management.

Factors affecting blood culture contamination rates and effective reduction measures

Blood culture collection is a crucial procedure used universally in hospital settings to identify bloodstream infections. A false positive culture arises when contamination occurs during culture collection or when handling the culture in the laboratory. These contaminated cultures cause inaccurate diagnoses resulting in longer hospital stays, increased cost, and unnecessary antimicrobial treatments. It is therefore vital to limit the rate of blood culture contamination. Here we discuss various factors that play roles in blood culture contamination rates. The roles of phlebotomy teams, the coronavirus disease 2019 pandemic, blood draw location, and hospital department on blood culture contamination rates will be discussed. Potential methods that can be deployed to decrease blood culture contamination rates will be compared.

Evaluation of the initial specimen diversion technique (ISDT) for reducing blood culture contamination in children: a prospective randomized controlled trial

Blood cultures are one of the important tools for laboratory diagnosis of bloodstream infection [1]. One of the main limitations of blood cultures is the occurrence of false-positive results caused by skin contaminants. False-positive results can impact on patient care, e.g., improper antibiotic treatment, additional investigations for possible infection, increased length of stay and higher costs [2,3]. Rates of blood culture contamination in children vary between centres but are typically not less than 3% [4].

Age &lt;18 years, malnutrition and immunosupression therapy: Risk factors for bloodstream infection caused by Coagulase Negative Staphylococci (CoNS)

Most blood culture contaminants are coagulase-negative staphylococci (CoNS), which are also the leading cause of nosocomial bloodstream infections. To date, no research in Indonesia has analyzed the potential causes of a CoNS infection in the bloodstream. The goal of this research was to better understand who is at risk for developing a CONS-related bloodstream infection while in a hospital setting. Secondary data from the CONS blood culture results at Dr. Kariadi Hospital Semarang were used in this retrospective cross-sectional study conducted between January 1 and December 31, 2016. The Vitek-2 Compact System (Biomerieux, USA) and the Kirby Bauer method (Clinical &amp; Laboratory Standards Institute (CLSI) of the USA) were used for the antibiotic identification and sensitivity testing, respectively. Multivariate with multiple logistic regressions and the Chi-Square test for categorical variables were used in the analysis. Among the study's 272 participants, 158 (58.1%) developed CONS-related bloodstream infections. Risk factors for central nervous system (CNS) bloodstream infection in 18-year-olds include preterm birth, low birth weight (LBW), compromised immunity, malnutrition, immunosuppressive therapy, and peripheral intravenous use. Age &gt;=18, malnutrition, and immunosuppression therapy all ranked high as risk factors in a multivariate analysis. Risk factors for CONS-causing bloodstream infections in people aged 18 include malnutrition and immunosuppressant therapy.

Single-center investigation on central-line-associated bloodstream infections and blood-culture contamination during the early months of the coronavirus disease 2019 (COVID-19) pandemic.

In this retrospective cohort study, we assessed central-line-associated bloodstream infections (CLABSIs) and blood-culture contamination frequency during the first pandemic wave. Coronavirus disease 2019 (COVID-19) was significantly associated with CLABSI and blood-culture contamination. In the COVID-19 cohort, malignancy was associated with CLABSI. Black race, end-stage renal disease, and obesity were associated with blood-culture contamination.

ISO 9001:2015 Internal Audits for Financial and Strategic Decisions in Reducing Blood Culture Contamination.

Blood cultures are vital diagnostic tests that detect harmful pathogens in a patient's bloodstream. In this study, we implemented a process-driven quality improvement program to reduce blood culture contamination rates. St Joseph Health (SJH) utilized the ISO 9001:2015 Internal Audit tool, failure mode effect analyses, and the Centers for Disease Control and Prevention's Hierarchy of Controls to identify opportunities for improvement and design effective corrective and preventive action plans. These actions included reeducation and ongoing coaching of staff on the blood culture collection process, reorganizing blood culture supplies on the nursing units, and adding multiple layers of supervision. A statistically significant relationship was identified between 2 variables ("contamination rate" and "cumulative cost difference"). The 2 variables had a negative association, demonstrating that as the contamination rate decreased, the cumulative cost difference increased, indicating potential cost savings. The estimated value added to the institution through this initiative was approximately $215 743 to $228 543 in potential cost savings. SJH significantly reduced the number of blood culture contaminations in the critical care division, evidenced by a controlled 6-month mean below 1%. Review of the 6-month mean as a reference point demonstrated the sustainability of the implemented corrective and preventive measures.