Blood Culture Contamination Rates Research Articles

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 <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

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.
 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.
 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.
 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.
 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.
 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.
 Conclusion: Features of patient history, demographics, and culture collection may be associated with higher blood culture contamination rates.
 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 < 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< 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.

Diagnostic Stewardship: A Systematic Review and Meta-analysis of Blood Collection Diversion Devices Used to Reduce Blood Culture Contamination and Improve the Accuracy of Diagnosis in Clinical Settings.

Blood culture contamination may lead to misdiagnosis, overutilization of antibiotics, and prolonged length of stay. Blood specimen diversion devices can reduce contamination rates during blood culture collection procedures. We performed a systematic literature review and meta-analysis evaluating the influence of blood specimen diversion devices in blood culture contamination rates. We searched Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science, from database inception to 1 March 2023, for studies evaluating the impact of a diversion device on blood culture contamination. Blood culture contamination was a positive blood culture with microorganisms not representative of true bacteremia, but rather introduced during collection or processing the blood sample. Random-effects models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 test. Of 1768 screened studies, 12 met inclusion criteria for this systematic literature review. Of them, 9 studies were included in the meta-analysis. Studies were substantially heterogeneous, but stratified analyses considering only high-quality studies revealed that venipuncture using a diversion device was associated with a significant reduction in blood culture contamination in comparison to the standard procedure of collection (pooled odds ratio [OR], 0.26 [95% confidence interval {CI}, .13-.54]; I2 = 19%). Furthermore, the stratified analysis showed that the adoption of a diversion device did not reduce the detection of true infection (pooled OR, 0.85 [95% CI, .65-1.11]; I2 = 0%). Blood culture diversion devices was associated with decreased contamination rates and could improve quality of care, reduce costs, and avoid unnecessary antibiotic use.

Effect of an initial specimen diversion device on blood-culture contamination rates and vancomycin usage: A quasi-experimental study.

Initial specimen diversion devices (ISDDs) are a potential solution for reducing blood-culture contamination rates. We report the implementation of an ISDD associated with a sustained reduction in blood-culture contamination rates for >18 months after implementation. We did not observe a clinically significant reduction in inpatient vancomycin usage.

Blood culture contamination in a tertiary care hospital: a retrospective three-year study

BackgroundBloodstream infections (BSI) are a leading cause of morbidity and mortality in hospitalized patients worldwide. A blood culture is the primary tool for determining whether a patient has BSI and requires antimicrobial therapy, but it can result in an inappropriate outcome if the isolated microorganisms are deemed contaminants from the skin. Despite the development of medical equipment and technology, there is still a percentage of blood culture contamination. The aims of this study were to detect the blood culture contamination (BCC) rate in a tertiary care hospital in Palestine and to identify the departments with the highest rates along with the microorganisms isolated from the contaminated blood samples.MethodBlood cultures that were taken at An-Najah National University Hospital between January 2019 and December 2021 were evaluated retrospectively. Positive blood cultures were classified as either true positives or false positives based on laboratory results and clinical pictures. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21. A p-value of less than 0.05 was considered statistically significant for all analyses.ResultsOut of 10,930 blood cultures performed in the microbiology laboratory from 2019 to 2021, 1479 (13.6%) were identified as positive blood cultures that showed microbial growth. Of these, 453 were blood culture contaminations, representing 4.17% of total blood cultures and 30.63% of the positive blood culture samples. The highest rate of contamination was in the hemodialysis unit (26.49%), followed by the emergency department (15.89%). Staphylococcus epidermidis was the most prevalent (49.2%), followed by Staphylococcus hominis (20.8%) and Staphylococcus haemolyticus (13.2%). The highest annual contamination rate was observed in 2019 (4.78%) followed by 2020 (3.95%) and the lowest was in 2021 (3.79%). The rate of BCC was decreasing, although it did not reach statistically significant levels (P value = 0.085).ConclusionThe rate of BCC is higher than recommended. The rates of BCC are different in different wards and over time. Continuous monitoring and performance improvement projects are needed to minimize blood culture contamination and unnecessary antibiotic use.

The Impact of Performance Improvement Interventions and Phlebotomy Staff Counseling on Blood Culture Contamination Rates: Experience of Security Forces Hospital, Makkah, Saudi Arabia

The Impact of Performance Improvement Interventions and Phlebotomy Staff Counseling on Blood Culture Contamination Rates: Experience of Security Forces Hospital, Makkah, Saudi Arabia

Development and validation of a standardized blood culture contamination definition and metric dashboard for a large health care system.

Blood culture contamination is a major problem in health care, with significant impacts on both patient safety and cost. Initiatives to reduce blood culture contamination require a reliable, consistent metric to track the success of interventions. The objective of our project was to establish a standardized definition of blood culture contamination suitable for use in a Veterans Health Administration (VHA) national data query, then to validate this definition and query. A secondary objective was to construct a national VHA data dashboard to display the data from this query that could be used in VHA quality improvement projects aimed at reducing blood culture contamination. A VHA microbiology expert work group was formed to generate a standardized definition and oversee the validation studies. The standardized definition was used to generate data for calendar year 2021 using a Structured Query Language data query. Twelve VHA hospital microbiology laboratories compared the data from the query against their own locally derived contamination data and recorded those data in a data collection worksheet that all sites used. Data were collated and presented to the work group. More than 50,000 blood culture accessions were in the validation data set, with more than 1,200 contamination events. The overall blood culture contamination rate for the 12 facilities participating was 2.56% with local definitions and data and 2.43% with the standardized definitions and data query. The main differences noted between the 2 data sets were deemed to be issues in local definitions. The query and definition were then converted into a national data dashboard that all VHA facilities can now access. A standardized definition for blood culture contamination and a national data query were validated for enterprise-wide VHA use. To our knowledge, this represents the first reported standardized, validated, and automated approach for calculating and tracking blood culture contamination. This tool will be key in quality initiatives aimed at reducing contamination events in VHA.

Prevalence of secondary blood stream infections in patients with SARS- CoV-2 infection in a tertiary care hospital in Sri Lanka: A retrospective analysis

Introduction: Secondary infections are an important cause of morbidity and mortality related to SARS-CoV-2 infection. Early administration of effective antimicrobials improves patient outcome of such infections. In the present study, we investigated secondary blood stream infections (BSI) among COVID-19 patients in Colombo North Teaching Hospital, Sri Lanka (CNTH). Methods: This is a descriptive study, performed to analyse blood culture positive events retrospectively in patients hospitalized with COVID-19 in our institution from 1st June 2021 to 30th November 2021. Results: Of a total 434 blood cultures received from SARS-COV-2 positive patients, the overall blood culture positivity rate was 25.3 % (110/434) of which 11.7% (51/434) were clinically relevant bacteraemias. The contamination rate was 13.7% (59/434). Of the 60 isolates from clinically relevant bacteraemias, 60% (36/60) were Gram negative organisms, 31.7% (19/60) were Gram positive organisms and 8.3% (5/60) were Candida spp. The most prevalent isolates were Enterococcus spp. (20%; 12/60) and Acinetobacter spp. (15%; 9/60). Higher rates of multi drug resistance were observed among Gram negative isolates. The proportion of 3rd generation cephalosporins and ciprofloxacin resistance among enterobacterales was 81.3% and carbapenem resistance among Acinetobacter spp. was 77.8%. A primary focus of infection could be identified in only 18 blood stream infections (BSI). Conclusion: A high rate of significant BSIs was detected in this patient cohort. Blood culture contamination rate among COVID-19 patients was higher than the usual rates in the institution. A high number of bacteraemias due to Enterococcus spp. and Acinetobacter spp. were noted and overall antibiotic resistance among Gram negative organisms was high.

The use of a diversion tube to reduce blood culture contamination: A “real-life” quality improvement intervention study

BackgroundBlood culture contamination is associated with health care costs and potential patient harm. Diversion of the initial blood specimen reduces blood culture contamination. We report results of the "real-life" clinical implementation of this technique. MethodsFollowing an educational campaign, use of a dedicated diversion tube was recommended prior to all blood cultures. Blood culture sets taken from adults using a diversion tube were defined as "diversion sets," those without, "non-diversion" sets. Blood culture contamination and true positive rates were compared for diversion and nondiversion sets and to nondiversion historical controls. A secondary analysis investigated efficacy of diversion by patient age. ResultsOut of 20,107 blood culture sets drawn, the diversion group included 12,774 (60.5%) and the nondiversion group 8,333 (39.5%) sets. The historical control group included 32,472 sets. Comparing nondiversion to diversion, contamination decreased by 31% (5.5% [461/8333] to 3.8% [489/12744], P < .0001]. Contamination was also 12% lower in diversion than historical controls [3.8% (489/12744) vs 4.3% (1,396/33,174) P = .02)]. The rate of true bacteremia was similar. In older patients, contamination rate was higher, and the relative reduction associated with diversion decreased (54.3% amongst 20-40-year-olds vs 14.5% amongst >80-year-olds). ConclusionsUse of a diversion tube in the ED reduced blood culture contamination in this large real life observational study. Efficacy decreased with increasing age, which requires further investigation.

A Quality Improvement Initiative on Reducing Blood Culture Contamination in the Emergency Department

IntroductionContaminated blood cultures may have detrimental effects on patients, the organization, and antimicrobial stewardship. Patients in the emergency department may need blood cultures collected before antimicrobial therapy. Contaminated blood culture samples may contribute to prolonged hospital stay and also are associated with delayed or unnecessary antimicrobial therapy. This initiative aims to improve the emergency department’s blood culture contamination rate that will eventually benefit the patients who will receive timely and proper antimicrobial therapy, and benefit the organization fiscally. MethodsThis quality improvement initiative used the Define–Measure–Analyze–Improve–Control (DMAIC) process. The organization targets blood culture contamination rate of ≤2.5%. Control charts were used to study how blood culture contamination rate changed over time. In 2018, a workgroup was formed to work on this initiative. Improved site disinfection using 2% Chlorhexidine gluconate cloth before the standard procedure of blood culture sample collection was initiated. Chi squared test of significance was used to compare blood culture contamination rates 6 months before and during feedback intervention as well as contamination rate from source of blood draw. ResultsBlood culture contamination rates 6 months before and during feedback intervention showed significant decrease (3.52% before intervention and 2.95% after intervention; P < .05). Contamination rates differed significantly based on the source of blood culture draw (7.64% via line, 3.05% via percutaneous venipuncture, and 4.53% via other; P < .01). DiscussionBlood culture contamination rate continued to decrease with the use of a predisinfection process with 2% Chlorhexidine gluconate cloth before blood sample collection process. Practice improvement also was evident with effective feedback mechanism.