Blood Culture Contamination Rates Research Articles

Illustration of the Financial Impact of Usage of Initial Specimen Diversion Devices (ISDD) or Continued Educational Initiatives on the Costs from Blood Culture Contamination

Abstract Introduction/Objective Blood culture contamination (BCC) has the potential to lead to additional healthcare system costs and harm to patient. Two ways to reduce BCC have been explored in the literature and are economically modeled including initial specimen diversion devices (ISDD) and continued education on phlebotomy. Methods/Case Report A literature review on the economic costs of BCC, ISDD efficacy, and phlebotomy education to reduce BCC rates was undertaken. The reported average BCC at a veteran affairs medical center (VAMC), its reported rate during a month of phlebotomy training, the cost of an ISDD device at VAMC, and the average wage for 4 hours of phlebotomy manager time for training was noted. An illustrative economic model involving 100 patients was used at BCC rates of 1%, 2%, and 3% along with what had been observed at the VAMC was used for economic modeling. Results (if a Case Study enter NA) It was previously reported by Skoglund et al that in laboratories with rapid diagnostic testing modalities (such as MALDI-TOF or PCR testing), the cost per BCC event is $13,026 versus $8,287 in costs for a negative blood culture. ISDD efficacy in the literature reviewed (74.1% to 87.5%), continuous education efficacy (16.2% to 57.8%), ISDD device cost ($17.70 per device), and the hourly wage of a phlebotomy supervisor ($29.34) were noted. The reported average BCC rate from a regional VAMC was 1.33%, and during the month with education, the rate was 0.5%. From a model of 100 patients, ISDD device savings ranged from $1,741.60-$2,376.63 (1% BCR), $5,253.20-$6,523.25 (2% BCR), and $8,764.79-$10,669.88 (3% BCR). Education savings ranged from $755.98-$2,727.41 (1% BCR), $1,523.70-5,466.55 (2% BCR), and $2,291.42-$8,205.69 (3% BCR). The observed impact of education at the regional VAMC would have resulted in savings of $650.83 per 100 patients. Conclusion Both education and ISDD devices can result in significant savings from the costs of BCC.

472 Blood Culture Contamination Rate as a Novel Way to Assess Safety of Ultrasound Guided Intravenous Catheters

472 Blood Culture Contamination Rate as a Novel Way to Assess Safety of Ultrasound Guided Intravenous Catheters

Implementing a quality improvement plan to reduce the blood culture contamination rate in pediatric patients: A quasi-experimental study.

Implementing a quality improvement plan to reduce the blood culture contamination rate in pediatric patients: A quasi-experimental study.

Blood Culture Contamination Mitigation: Sustaining Success and Stewardship Systemwide

Background: False-positive blood cultures compromise care; extended stays, Clostridioides difficile risk increases and renal woes tagged to antibiotic alms contribute to the doubling of patient in-hospital mortality that is observed relative to true negative diagnostic results. False-positive affiliated central line-associated bloodstream infection reports can further obfuscate the quality of care provided. Between personnel performance pressures, laboratory resource losses and the risk for financial penalty under Value-Based Purchasing and Hospital-Acquired Condition Reduction Programs (Centers for Medicare & Medicaid Services), it becomes difficult to brush aside the burden of a non-zero blood culture contamination rate. Following unsuccessful and unsustainable endeavors that included educational exercise and waste tube employment, initial-specimen diversion devices designed to shift performance burdens from technicians to technology were co-opted in an effort to secure reliable blood culture contamination rate reductions. Methods: A 3.6% blood culture contamination rate was observed systemwide prior to intervention, which began in 2020. Among seventeen facilities that share a data system, twelve co-opted initial-specimen diversion device technology as the evidence-based anchor to a trifurcate intervention strategy that included value analysis and cultural curation. Results: The 2023 systemwide blood culture contamination rate was 1.95%; down from 2.8% in 2022 and 3.2% in 2021. The average cost per false-positive event was $2,111, with intervention amounting to systemwide savings of $4.1 million in 2023 as approximately 1,920 patients avoided false-positive incidents. Critical to year-over-year systemwide uptick in adoption of interventive technology was consistent and near real-time communication to caretakers regarding outcomes. Conclusion: The sustained success of the multifactorial solution showcased herein stems from the coupling of an evidence-based action with an ongoing assessment of value and communication channels carefully constructed to celebrate and perpetuate value observed. Layered uncertainties often cloud the crux of a multifactorial solution to a complex conundrum; for many decades the literature-supported solution to high blood culture contamination rates was to educate every person involved in every possible way. Only recently, following recommended practice revisions endorsed by the Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention, did it become apparent nationwide that education alone was insufficient; some contaminant pathways persist without meticulously mechanical closure. Antimicrobial stewardship requires the respectful removal of adaptable pressures from microorganisms, but the inverse is equally important; by setting an ambitious systemwide blood culture contamination rate target of 1% or less, it is hoped that all facilities involved herein respond to this pressure with optimism, introspection and innovation.

Reducing Blood Culture Contamination Rates: Introduction of a Combined Education and Skin Antisepsis Intervention.

Background. Blood culture contamination (BCC) is an important quality concern in clinical microbiology as it can lead to unnecessary antimicrobial therapy in patients and increased workload for laboratory scientists. The Clinical Laboratory and Standards Institute recommend BCC rates to be <3 % and recently updated guidelines have set a new goal of 1 %. The aim of this project was to design and implement interventions to reduce BCC rates at our institution. Methods. We introduced a combined education and skin antisepsis intervention in a large Model 4 academic teaching hospital in the South of Ireland. BD ChloraPrep skin antisepsis applicators (2 % chlorhexidine gluconate/70 % isopropyl alcohol), licensed for use for blood culture specimen collection, were introduced, replacing Clinell (2 % chlorhexidine gluconate/70 % isopropyl alcohol) wipes. In addition, a multimodal education programme was designed and delivered. This consisted of a video demonstrating the recommended blood culture specimen collection technique using the new applicators as well as simulation training for all interns. The video was uploaded to the intranet as an educational resource available to all staff. Results. The interventions were implemented in July 2022 and BCC rates pre- and post-intervention were calculated. The average BCC rate for the 12 months preceding the intervention (July 2021 to July 2022) was 2.56 % with highest rates in the Emergency Department. This compared to an average rate of 2.2 % in the 12 months post-intervention (July 2022 to July 2023). In comparing the two rates the reduction in BCC rates between the two periods was not statistically significant (P=0.30). Conclusion. Overall BCC rates reduced but the difference between the two periods did not reach statistical significance. The resource-intensive nature of providing regular and timely feedback of contamination rates and the larger impact of in-person education and training over virtual modalities may explain the modest reduction. Further investments in these areas, particularly in the Emergency Department, will be necessary to further reduce rates in line with new recommendations.

Reducing Blood Culture Contamination in Adult Patients with Cancer Presenting to the Emergency Department

Background: Infection is one of the most common complications of cancer and cancer treatment. Most patients admitted for fever or infection come through the Emergency Department (ED), which is a primary site for blood culture collection. Contamination of blood cultures complicates the diagnoses, compromises quality of care, leads to unnecessary antibiotic exposure and increases financial burdens. It may also lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was over twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses, instead of phlebotomists, draw most blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the ED contamination rate by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared ED contamination rates versus other hospital inpatient floors and outpatient centers over a three-month period. We then evaluated the contamination rates of ED nurses versus ED phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and potential interventions were ranked on a prioritization matrix. Results: We identified use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as critical contributors to increased contamination rates in the ED. Our intervention was creating premade blood culture kits promoting the use of chlorhexidine swabs through availability and easy access in the fast-paced ED environment. Ten cubic centimeter (cc) syringes in the kits encouraged withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off ED nurses at the bedside, implementing education and adherence in using the blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. A reduction in blood culture contamination from 2.46 percent to 1.89 percent was seen after two months. Conclusions: A guideline-driven, standardized blood culture collection process followed by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available premade blood culture kits improve compliance with materials and techniques associated with best practices.

Back to Basics: Blood Culture Contamination Reduction Across a Multicenter Academic Health System

Background: Blood culture contamination is common in healthcare and contributes to diagnostic uncertainty, unnecessary treatments and follow-up testing, increased length of stay, higher rates of reportable healthcare-associated infections and events, over utilization of resources and staff including consultative care, and undue emotional stress to patients. The national benchmark for institutional blood culture contamination rates as recommended by The American Society for Microbiology (ASM) and the Clinical Laboratory Standards Institute (CLSI) is &lt; 3 %. Our institution’s overall rate was 8.9% with the highest burden being from our Emergency Department (ED) locations. We formed a multidisciplinary team aimed to reduce these rates through efforts centered around education and simplification of the collection process. Method: Working closely with and gathering feedback from nursing staff, nurse educators, and supply chain, we developed a blood culture collection kit that included all items necessary for blood culture collection thus eliminating the need for nurses to gather these items individually prior to collection. Additionally, simple step-by-step educational materials (Fig. 1) detailing the collection technique were provided. Education was presented at nursing huddles and skills fairs prior to kit roll-out. Blood culture kits were then stocked in place of individual blood culture collection bottles in all ED stock rooms in August 2022. Result: The 12-week pre-intervention period found 249 contamination events from 4265 total collections deriving a contamination rate of 5.8% across our health system’s four ED locations. During a 12-week post-intervention period following kit roll-out, 116 contamination events occurred from 3629 total collections deriving a contamination rate of 3.2% across our four ED locations. Given our results, we ultimately rolled this out to all units in all locations of our health system. When including all time from kit rollout to present (August 2022 to November 2023, 16 months), there were 1077 contamination events from 43379 total collections deriving an overall contamination rate of 2.5%. When compared to the 16 months prior to the kit rollout (April 2021 to July 2022) there were 1803 contamination events in 49335 total collections (3.7% contamination rate) deriving an overall percent reduction of 32.1%. Conclusion: We were able to decrease our health system’s blood culture contamination rate through simple interventions aimed at reducing the mental burden on nursing staff by developing a blood culture collection kit and educational materials. Since implementation of the kits, we have continued to maintain lower contamination rates as evident by our 16 month follow up period.

16 Sociodemographic and Hospital-Level Characteristics Associated with Hospital-Onset Bacteremia in the Neonatal Intensive Care Unit

OBJECTIVES/GOALS: The primary objective is to measure the independent association of hospital-level and sociodemographic variables on the rate of hospital-onset bacteremia among infants admitted to the neonatal intensive care unit in a United States of America retrospective cohort. The secondary outcome will be relative blood culture collection rate. METHODS/STUDY POPULATION: The study is an analysis of a retrospective cohort comprised of infants admitted to 322 neonatal intensive care units (NICUs) in the United States of America between 2016-2021. The primary outcome will be hospital-onset bacteremia (HOB), defined as a positive blood culture with a bacteria or fungi after day 3 of admission. Independent risk factors will include birthweight, postnatal age, central venous catheter presence, sociodemographic variables (race, ethnicity, insurance status and ZIP code-level demographic data from the US Census American Community Survey (ACS), and hospital-level variables. Infants will be stratified by sociodemographic groups and a Poisson model will be utilized to measure the adjusted association between risk of HOB and clinical and hospital-level variables. RESULTS/ANTICIPATED RESULTS: I anticipate that infants in sociodemographic groups with a history of socioeconomic marginalization will have a higher unadjusted rate of HOB; however, sociodemographic variables will not be independently associated with HOB risk after adjusting for markers of hospital quality and acuity, such as quartiles of the following: mean admissions per year, percentage of infants born &lt;1500g, annual blood culture contamination rate, and percentage infants born at another facility. DISCUSSION/SIGNIFICANCE: Neonatal bacteremia has high morbidity and mortality; however, its contribution to known infant mortality inequities is unknown. This study will estimate the burden of infant HOB stratified by sociodemographic groups and measure the independent association of sociodemographic and hospital-level variables on the adjusted rate of HOB.

Effectiveness of Multimodal Intervention to Improve Blood Culture Collection in a Tertiary Care Hospital.

Introduction and methods Blood culturing has become one of the backbone investigations for septicemia, fever of unknown origin, etc. This study was conducted to test the effect of multimodal interventions on the practical skills of healthcareworkers (HCWs), raise awareness regarding the importance of aseptic blood culture collection practices, and increase compliance with the specific steps to be followed. Hence, this current interventional study was aimed at comparing the rate of isolation of contaminants grown among the blood culture specimens, assessing the knowledge, attitude, and practice (KAP) of HCWscollecting the blood culture specimen on various aspects of sample collection, educating the nursing staff regarding blood sample collection using a structured, pre-formed checklist, and emphasizing best practices for blood culture collection. All of the study's objectives were successfully met within the time frame specified. Using a pre-formed checklist and a Google form for KAP analysis eased the calculation. Results On analysis, the blood culture contamination rate in the pre-interventional phase dropped drastically from 6.16% to 3.03% in the post-interventional phase. The educational sessions conducted are a paramount reason for the reduction in the contamination rate. The HCWs were the least compliant towards the eighth step in the checklist (regarding palpation of skin); however, that too increased from 66.93% and 64.51% to a whopping 82.25% and 83.06%, respectively, with a chi-squarevalue of 0.03 and a p-valueof 0.85 (not significant). Conclusion Implementation of interventional studies as an audit like this in tertiary care hospitals can result in a significant reduction in blood culture contamination rates and can also improve the compliance of HCWs with blood culture protocols. This, in turn, can overall improve the effectiveness of blood culture (BC) testing and reduce mortality and morbidity in tertiary care hospitals. Further research can be conducted to brainstorm more methods to increase the compliance of HCWs. Better monitoring strategies can also be set to ensure low contamination rates. Additionally, some other methods can be derived to locate the source of contamination within the hospital environment and thus eliminate it. Similar interventions can be conducted for a longer duration of time to further reduce the blood culture contamination rate below 3% (as per the recommendations).

Blood culture contamination rate as a pre-analytical quality indicator: 12-month data analysis from a metropolitan microbiology laboratory

Blood culture contamination rate as a pre-analytical quality indicator: 12-month data analysis from a metropolitan microbiology laboratory

Safeguarding Accuracy: The Impact of Interventions on Reducing Blood Culture Contamination.

Blood culture is the gold standard for diagnosing bacteremia and direct the physicians to select appropriate antimicrobials. In hospitals, blood culture contamination (BCC) is a common problem that has a detrimental effect on patient outcomes. Hence, we implemented strategies in our tertiary care setup, for training phlebotomists and nurses in proper blood sampling techniques, and assessed their effectiveness in reducing BCC rates. This interventional study was conducted at the Indus Hospital, Karachi, Pakistan from 1st January 2021 to 30th June 2023. All blood cultures received from different departments of the hospital were included. The 2.5-year study period was divided into pre-intervention and intervention periods, with monthly monitoring of BCC. The BCC data between 1st January 2021 and 31st December 2021 was taken as the baseline pre-intervention period and the next 1.5 years comprised the intervention period (1st January 2022-30th June 2023). To improve compliance, various strategies were implemented, such as regular training sessions, didactic sessions, and re-competencies. A total of 86 774 Blood cultures were received from all departments of the hospital, out of which n = 30 672 were received in the pre-intervention period whereas, n = 56 102 were received in the intervention period. Mean BCC rate in the pre-intervention period was found to be 4.6%. However, after the implementation of different measures to reduce BCC, the contamination rate decreased to a mean of 3.1% by the end of the intervention period. Emergency department accounted for the highest proportion of BCC in the pre-intervention and intervention periods. We decreased BCC in our tertiary care setup by implementing a simple and inexpensive collaborative intervention, and came to the conclusion that the higher incidence of BCC was probably caused by factors unique to the emergency department and provided measures to successfully address them.

Blood Culture Contaminations: Interventions and Culture Characteristics

Background/Objective:Blood cultures are collected in patients with serious illnesses who are at risk of bacteremia. However, some blood cultures are contaminated which may lead to adverse health outcomes for patients such as an increased length of stay and the unnecessary utilization of antibiotics. The emergency department (ED) has been found to be a frequent source of blood culture contamination. We aimed to identify characteristics and consequences of blood culture contamination at IUH Bloomington.&#x0D; Methods:Chart review of blood cultures collected at IUH Bloomington in January 2023 was utilized to extract variables including intravenous location and hospital location of blood draw, number and identification of antibiotics given, length of stay, and organisms identified in the blood cultures. Data were securely maintained in REDCap.&#x0D; Results:The median length of stay for individuals with contaminated cultures in January was found to be 4 days which was comparable to individuals with negative cultures. Most commonly, contamination occurred from the ED with it being responsible for 33/34 contaminated cultures. The most frequently utilized antibiotic across all groups was vancomycin – with both the positive and contaminated groups having a greater percentage of individuals receiving a course of the antibiotic with a mean course of 3.43 days. The most common contaminant was found to be coagulase negative Staphylococcus.&#x0D; Conclusion and Implications:Lower rates of blood culture contamination may contribute to lower length of stay and improved antibiotic de-escalation strategy. Identification of culture characteristics may guide future endeavors in infection control policies.

Blood Culture Contamination Rates in Bloomington, Association with Patient History

Background/Objective: Blood cultures are vital for diagnosing infections and directing antibiotic therapy to causative organisms in systemically ill patients. Blood culture contamination contributes to increased costs, longer lengths of stay, and unnecessary antibiotic use. Certain patient histories and demographics have been associated with higher contamination rates. Identifying contamination risk factors within the hospital may allow for improvements in patient care.&#x0D; Methods: Patient demographics, history, and blood culture information were identified through a chart review for all adult blood cultures collected in January 2023 at the IU Health Bloomington Hospital. Patient characteristics collected included age, race, ethnicity, BMI, and a number of comorbidities (COPD, diabetes, etc.). Blood culture characteristics, including the number of cultures drawn, hospital setting, etc., were also collected. A comparative analysis was performed between positive, negative, and contaminated cultures.&#x0D; Results: In January, 443 adult patients had blood cultures collected at IUH Bloomington hospital, with contamination in 33 cases (7.4%). Patients with contaminated cultures had a higher prevalence of hypertension (75.8%) compared to those with negative cultures (61.9%). Type II diabetes was more prominent in the contaminated culture group (36.4%) than the negative culture group (31.3%). 15.2% of patients with contaminated cultures resided in extended care facilities, while only 12.3% of patients with negative cultures did so. Most contaminated cultures (97%) were drawn in the emergency department, with 3% collected in medical-surgical units/floor level of care.&#x0D; Conclusion: Features of patient history, demographics, and culture collection may be associated with higher blood culture contamination rates.&#x0D; Scientific/Clinical/Policy Impact and Implications: This data will be expanded into the entire 1st quarter of 2023 to further identify trends in culture contamination. Findings may present opportunities for quality improvement in patient care as IUH Bloomington looks to further reduce their rates of contaminated cultures.

Impact of quality improving interventions on blood culture contamination rate- A prospective observational study

Background: Blood cultures (BC) is the gold standard for diagnosis of bacteremia but false positive blood cultures due to specimen contamination can lead to increased usage of unnecessary antibiotics and have negative impact on antimicrobial stewardship program. Overgrowth of contaminants can also obscure growth of genuine pathogens and hamper accurate diagnosis. The aim of this study is to evaluate effectiveness of Quality improving (QI) interventions to reduce the blood culture contamination rate Material and Methods: Prospective observational study, conducted at a public sector hospital, for a total duration of 6 months. A taskforce developed and implemented QI interventions to reduce blood culture contamination, and evaluated effectiveness of these interventions by comparing contamination rates prior to and after implementation of the intervention. Results: The post-intervention average contamination rate was significantly lower with the mean contamination rate of 4.7 ± 1.5% as compared to baseline BC contamination rate which was 10.6 ± 1.8% (p=0.013) Conclusion: Quality improving (QI) interventions significantly reduced the blood culture contamination rate. Keywords: Quality improvement, Interventions, Blood culture, Contamination.

Review of Blood Cultures Taken From Arterial Lines in James Cook University Hospital: Contamination Analysis And Comparison With Venous Samples

BACKGROUND: Blood cultures are crucial diagnostic tools for identifying and treating bloodstream infections. Traditionally, venous blood is the preferred source for sample acquisition, but arterial lines offer an alternative. However, concerns regarding contamination and diagnostic accuracy have been raised, questioning the reliability of arterial line blood cultures. This study aimed to evaluate the contamination rates of arterial line blood cultures at James-Cook University Hospital (JCUH), UK and compare them with venous samples to understand their clinical utility better. METHODS: A comprehensive retrospective review analysed 17,643 blood culture samples collected between September 2022 and March 2023 at JCUH. Among these, 109 arterial line blood cultures and 785 venous peripheral adult samples were included for data analysis. Contamination rates were calculated as the number of positive blood cultures with contaminants per total positive samples (arterial or venous). The incidence of contamination was defined as the number of total blood cultures reported with contaminants per total samples (arterial or venous). No discrimination was made based on the number of contaminants found. Clinical information accompanying the blood cultures, such as the specification of arterial lines as 'new' samples, was also considered. RESULTS: The overall contamination rate at JCUH was found to be 4.99%. Specifically, the contamination rate for venous samples was 49.26%, while arterial samples had a higher contamination rate of 56.52%. The incidence of contamination from arterial samples was 11.92%, significantly higher than the incidence rate for venous samples at 3.18%. Most arterial samples were requested from intensive care units (ICUs) and highly dependent wards (HDUs), indicating potential areas for targeted interventions to improve blood culture collection practices. CONCLUSION: Arterial blood cultures demonstrated higher contamination rates compared to venous samples, raising concerns about their reliability. Contamination in arterial samples, particularly when collected from critically ill patients in ICUs and HDUs, can lead to inappropriate use of antibiotics, delayed, or missed diagnosis, and suboptimal patient outcomes. The study recommends targeted interventions to improve arterial blood culture collection practices and further training for healthcare workers involved in arterial line care. Encouraging the use of only 'new' arterial lines and implementing standardized protocols can help reduce contamination rates. Furthermore, the study identified certain limitations, such as potential human errors in data analysis and the need for a larger dataset of arterial line cultures. Extending the analysis to compare different sample sources like CVCs, Hickman lines, and central lines could provide a more comprehensive understanding of contamination rates across various culture collection methods. In conclusion, venous samples showed higher clinical favourability with a lower contamination rate, providing increased dependability for accurate diagnosis and management. Although some studies have not shown clear superiority of arterial samples over venous samples, this analysis highlights considerable differences in contamination rates, suggesting a potential inferiority of arterial blood culture samples. While efforts can be made to optimize the consistency of arterial samples and reduce contamination rates, their use should be approached with caution. Implementing the recommended measures is essential for accurate diagnosis, improved patient outcomes, and effective antibiotic management in clinical practice.

Laboratory approaches to determining blood culture contamination rates: an ASM Laboratory Practices Subcommittee report.

Blood culture contamination (BCC) is the presence of specific commensal and environmental organisms cultivated from a single blood culture set out of a blood culture series and that do not represent true bacteremia. BCC can impact quality of care and lead to negative outcomes, unnecessary antibiotic exposure, prolonged hospital stays, and substantial costs. As part of the laboratory's quality management plan, microbiology laboratory personnel are tasked with monitoring BCC rates, preparing BCC rate reports, and providing feedback to the appropriate committees within their healthcare system. The BCC rate is calculated by the laboratory using pre-set criteria. However, pre-set criteria are not universally defined and depend on the individual institution's patient population and practices. This mini-review provides practical recommendations on elaborating BCC rate reports, the parameters to define for the pre-set criteria, how to collect and interpret the data, and additional analysis to include in a BCC report.

BD Chloraprep™ (“2 % chlorhexidine with 70 % isopropyl alcohol”) versus povidone iodine plus alcohol, for prevention of blood culture contamination at children: An investigator-initiated, open-label, single centre, randomized controlled trial

IntroductionOne of the important problems that lower the diagnostic value of blood culture is contamination with skin organisms. The povidone-iodine, alcohol, and chlorhexidine gluconate alcohol are used for disinfection prior to blood sampling for culture. MethodsThe investigator-initiated, open label, single centre, randomised trial compared blood culture contamination rates between two groups of patients in which using a povidone iodine skin-preparation process with the contamination rate for using “2 % chlorhexidine with 70 % isopropyl alcohol” skin-disinfection. The patients who required sampling for blood cultures were included in the study and study period was from 15 March 2023 to 15 July 2023. ResultsA total of 400 blood cultures were obtained during the study, including 133 in the study group and 267 in the control group. In the total blood cultures, 11.75 % (n = 47) had microorganism isolation. Among them 39 (9.75 %) were contaminants and 8 (2 %) of them were true pathogens. The contaminant microorganisms were as following; 34 coagulase-negative Staphylococci, 3 Micrococcus spp, and 2 Streptococci viridans. The blood culture contamination rate in the study group was 5.3 % (n = 7) and 12.0 % (n = 32) in the control group, and significantly lower in the study group (p = 0.033). There is no significant difference regarding skin related side effects between two groups. ConclusionsThis study, showed that 2 % chlorhexidine gluconate in 70 % isopropyl alcohol is more efficacious in children than 10 % povidone-iodine preparations for disinfecting the skin prior to blood specimen collection for prevention of blood culture contamination.

172. Impact of a quality improvement re-training program on the blood culture volume, yield and contamination rates; experience from South India

Abstract Background Blood cultures help to detect causative agents in bacteremia and are important for targeted therapy. Adequate blood culture volume is considered as 8-10ml in each bottle and at least 2 aerobic and 2 anaerobic blood culture bottles are recommended. Inadequate blood culture fills are common and may affect yield. Figure 1 Methods The study was done in our healthcare facility-KIMSHEALTH, Trivandrum, India. Pre-intervention period was between May 2021 and June 2021; post-intervention was between May 2022 and June 2022. The intervention was through plan/do/study/act (PDSA) cycles and included multiple training sessions to the phlebotomy team regarding adequate fill volume which is 8-10 ml in each blood culture bottle. Training for maintaining asepsis during collection was reinforced. All blood culture samples received in the hospital microbiology laboratory during the above period were included in this study and compared between the pre-intervention and post-intervention period. Pediatric blood culture samples were excluded. Results Blood culture samples studied during pre and post intervention period were 1428 and 1716 respectively. In the pre-intervention phase adequate fill volume was noted in 30.81% bottles (figure 1), while in the post intervention adequate fill volume was noted in 68.06% bottles (p &amp;lt; 0.01). Blood culture contamination rate was 3.01% in the pre-intervention period which improved to 2% in the post-intervention period and the difference was significant (p&amp;lt; 0.01). Blood culture yield of a pathogenic organism did not show significant difference after the intervention (11.2% in pre-intervention group Vs 11.45% in post intervention group). Conclusion In this study, an improvement was noted in the blood culture fills by 38% and contamination rate reduced by 1%. Though there was no significant increase in blood culture yield with intervention, the reduction in contamination was noted which will reduce unnecessary antibiotic initiation. Disclosures All Authors: No reported disclosures

2440. Central Line-Associated Bloodstream Infection Incidence Reduction Accompanies Initial-Specimen Diversion Device Adoption

Abstract Background Established lines are poor sites for sampling blood (frequently host to enterococci and Candida species) but peripheral venipuncture is an imperfect alternative as antiseptics struggle to eliminate deeply embedded microorganisms. State-of-the-art initial-specimen diversion device (ISDD) use can facilitate near-zero blood culture contamination rates, but impact on central line-associated bloodstream infection (CLABSI) incidence is unclear. Methods Intervention took place within a Joint Commission-accredited, 200-bed, acute-care community hospital serving nine Southeastern United States counties toward the objective of reduced CLABSI reporting. From September 2021 through March 2023, ISDD use augmented all peripheral venipuncture sample collection for adult patient blood culture. CLABSI reporting and the associated National Healthcare Safety Network (NHSN) standardized infection ratio (SIR) data for the 18-month intervention period was compared to the preceding 18-month period. Results For the 18 months prior to ISDD use, 6.5 CLABSIs were predicted and 17 CLABSIs were reported. For the 18 months during which ISDD use augmented standard procedure, 5.5 CLABSIs were predicted and 3 CLABSIs were reported. ISDD use accompanied an 80% reduction in SIR, from 2.6 to 0.5. Conclusion The study period coincided with the COVID-19 pandemic, a nationwide struggle with considerable quality control shortcomings observed in this space that, by juxtaposition, reinforce the strengths of the intervention. SIRs are the primary means of tracking healthcare-associated infection trends, and financial penalties follow performances failing to meet predictions. As CLABSI reporting throughout the intervention period was dramatically below NHSN prediction, the author concludes that ISDDs have standard-of-care potential and encourages further study in the interest of antimicrobial stewardship and quality control. Disclosures All Authors: No reported disclosures

Reducing blood culture contamination in adult patients with cancer presenting to the emergency department.

393 Background: Fever and leukocytosis are among the most common complaints for cancer patients presenting to the Emergency Department (ED). Most patients admitted for fever or infection come through the ED, which is therefore a primary site for blood culture collection. Contamination of these cultures can increase the clinical and financial burdens for the patients, the medical team, and laboratory staff. It may lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was more than twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses rather than phlebotomists draw the majority of blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the contamination rate in the ED by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared contamination rates of the ED versus other hospital floors and outpatient centers over three months. We then evaluated the contamination rates of ED nurses versus phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and then potential interventions were ranked on a prioritization matrix. Results: We identified the use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as the critical contributors to the increased contamination rates in the ED. Our intervention was to create premade blood culture kits that promoted the use of chlorhexidine swabs by ensuring availability and easy access in the fast-paced ED environment. Ten cc syringes in the kits encouraged the withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off the ED nurses at the bedside, implementing education and adherence to the use of blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. Following two months of these interventions, there was a reduction in blood culture contamination from 2.46 percent to 1.89 percent. Conclusions: A guideline driven, standardized blood culture collection process adhered to by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available and premade blood culture kits improve compliance with the materials and techniques associated with best practices.