Reducing Blood Culture Contamination Research Articles

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.

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.

382. A Multifaceted Intervention to Reduce Blood Culture Contamination in Medical and Surgical Wards: A Cluster Randomized Controlled Trial

Abstract Background Blood culture (BC) is a standard diagnostic testing of bloodstream infection. Inappropriate blood sampling may lead to BC contamination causing antimicrobial overuse and adverse outcomes. Several individualized interventions during blood sampling are applied to reduce BC contamination. However, the efficacy of a multifaceted intervention applied to nursing staff for reducing the contamination rate has yet to be thoroughly studied. Methods From August 2020–January 2021, we conducted a 1:1 cluster-randomized controlled trial in 6 medical and 6 surgery wards. Six wards (3 medical, 3 surgery) as the intervention arm received the multifaceted intervention comprising a multimodal educational program, regular surveillance, and feedback. The other six wards (3 medical, 3 surgery) as the control arm received standard care. Participant nurses responsible for BC collection had to answer the pre- and post-study questionnaires to score their background knowledge on appropriate BC sampling. Clinical data and microbiological results were also collected. Results Of 3,630 blood culture bottles, 304 (8.4%) were culture positive, with an equal number of true bacteremia and contaminated bottles in both arms. The pre-study contamination rate was 2.2-2.5%. After applying the interventions, the contamination rate was 2.3% in the intervention arm and 3.2% in the control arm (p=0.535). Coagulase-negative staphylococci were the most common contaminants (12.8%). Factors associated with contaminated BC included pulmonary diseases (p=0.006), length of hospital stay (p=0.004), blood sampling at 7:00-15:00 (p=0.001), and delayed time to positivity (23.49 h, p< 0.001). In addition, nurses who received the interventions achieved overall scores in post-study questionnaires significantly more than nurses who did not (p< 0.001). Conclusion The multifaceted intervention can maintain a lower contamination rate throughout the study period. It may be a strategy to improve knowledge of an appropriate BC collection for medical staff. This study demonstrated that comorbidity, length of hospitalization, time of blood sampling, and time to culture positivity likely influenced BC contamination. 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.

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.

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.

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.

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.

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].

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.

Update Review to Reduce Blood Culture Contamination

The incidence and mortality rate of sepsis is increasing worldwide. Rapid and accurate detection of bacteremia and fungemia is essential to improve the patient’s condition. Health care providers, nurses, and possibly many laboratory staff are usually not well trained in proper blood culture techniques.The present guideline addresses the clinical importance of blood culture, its applications, and the correct technique for detecting pathogenic microorganisms that cause sepsis, and attempts to explain the place of blood culture in the management of sepsis and the appropriate method for obtaining a blood sample for culture. Describe false positives to reduce.Detection of bacteremia or fungi by blood culture is very important and vital in the management of patients with infection and can lead to the selection of appropriate antibiotics. Blood cultures (BCs) are important routine tests that are conducted in the clinical microbiology laboratory. Unfortunately, the common rate of BCs contamination is high which led to many clinical and economic consequences. The phlebotomy teams of blood sampling are very important to effectively reduce BCs contamination rate. Therefore, we conducted the current study to update our knowledge about the phlebotomy performances

Strategies on Reducing Blood Culture Contamination and Improving Differential Diagnostic Accuracy Among Cancer Patients

Strategies on Reducing Blood Culture Contamination and Improving Differential Diagnostic Accuracy Among Cancer Patients

114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

BackgroundBlood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We have assessed the effectiveness of one blood diversion device in a prospective trial performed at the two separate emergency departments (EDs) of a three-campus Academic Medical Center.MethodsA multi-phase prospective crossover trial was performed with the blood diversion device initially in use at one ED (Memorial) and standard equipment at the other ED (University) for 10 weeks. After a washout phase, a second 10-week study phase used the blood diversion device in the other ED (University) and standard equipment at the first ED (Memorial). Contaminants were identified by the clinical microbiology lab using standard criteria, and further defined by independent retrospective review by 3 infectious disease physicians prior to statistical analysis. An intention-to-treat analysis was performed, and Chi-square tests were used to compare contaminant rates among samples obtained using the blood diversion device versus standard equipment.Results5,675 blood samples were obtained with 5,661 samples analyzed after 14 were deemed inconclusive by the ID physician review. There were 1,719 samples obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected during diversion device periods and 2,825 during standard equipment periods. Based on the ID physician review, the contaminant rates were 1.9% in diversion device periods versus 2.9% in standard equipment periods (P = 0.018). There was a marked difference in blood culture contamination rates between the two EDs with contaminant rates at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively.ConclusionThe blood diversion device was able to significantly lower blood culture contamination rates overall by 1% at the institution’s two EDs (34% relative reduction), with a stronger effect noted at the campus with both a level 1 trauma center and transplant programs. Disclosures All Authors: No reported disclosures

Initial Specimen Diversion Device® reduces blood culture contamination and vancomycin use in academic medical centre

In suspected bloodstream infections, accurate blood culture results are critical to timely diagnoses and appropriate antibiotic administration. An Initial Specimen Diversion Device®, Steripath® (Magnolia Medical Technologies, Seattle, WA, USA) was evaluated for efficacy in reducing blood culture contamination at Brooke Army Medical Center (6.8% six-month contamination rate prior to intervention) in a six-month quality improvement project. Blood cultures in the emergency department were collected using either Steripath or the standard method. Blood samples of 20 mL were cultured into an aerobic and anaerobic medium and incubated for five days using an automated microbial detection system immediately after collection. Positive bottles were Gram-stained and plated. Rapid molecular polymerase chain reaction identification was performed on all first positive bottles within a blood culture set for each admission or ED visit. Speciation was deduced during antimicrobial sensitivity testing using the Vitek-2 instrument. Seven out of 1016 (0.69%) contamination events occurred when using Steripath vs 53 out of 800 (6.6%) contamination events when using the standard method. Steripath use was associated with a 90% lower incidence of blood culture contamination vs the standard method. Post study, Steripath use was implemented as standard practice hospital-wide, and a retrospective data analysis attributed a 31.4% decrease in vancomycin days of therapy to Steripath adoption. Using Steripath significantly decreased blood culture contamination events for bacterial bloodstream infections compared to the standard method. Subsequent adoption of Steripath reduced overall vancomycin usage. With widescale implementation Steripath could bolster antibiotic stewardship, mitigating antibiotic resistance caused by unnecessary antibacterial treatments.

Blood Culture Contamination in a Community Hospital- less than 2% is achievable

Abstract Introduction/Objective Blood cultures are commonly obtained to evaluate the presence of bacteria or fungal infection in a patient’s bloodstream. The presence of living microorganisms circulating in the bloodstream is of substantial prognostic and diagnostic importance. A positive blood culture indicates a reason for the patient’s illness and provides the etiological agent for antimicrobial therapy. Collection of blood culture is an exact process that requires time, the proper order of draw, and following of correct protocol. The busy Emergency department that requires multiple demands for nurse’s time, turnover of staff, rushing from one task to another can result in the improper collection and false-positive blood cultures. The national benchmark is set at 3% by the American Society of Clinical Microbiology (ASM) and The Clinical and Laboratory Standard Institute (CLSI). False-positive blood culture results in increased length of stay and unnecessary antimicrobial therapy, resulting in an increased cost burden to the hospital of about $5000 per patient. Methods/Case Report At our 150-bed community hospital, 26 beds Emergency Department, we have come a long way in reduction of our blood culture contamination rates from upwards of 4% to less than 2%, far lower than the national benchmark. Results (if a Case Study enter NA) NA Conclusion There are multiple devices available from various manufacturers claiming to reduce blood culture contamination. These devices do reduce blood culture (BC) contamination but at an added cost of the device. The rate of BC can be reduced and less than 3% is achievable by materials available in the laboratory. We have achieved this by providing training to every new staff by demonstration and direct observation, providing everything required for collection in a kit, using proper technique, the inclusion of diversion method that involves the aseptic collection of a clear tube before collecting blood cultures, and following up monthly on any false positive blood cultures.

Decreasing Blood Culture Contamination Rates When Using an Initial Peripheral IV: Implementing the 5 P's and Using a Closed System Device

Blood culture remains the gold standard for the diagnosis and treatment of bacteraemia and is the first-line tool for detecting bloodstream infections [1]. Research shows that the emergency department (ED) is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline-based infection prevention practices [2]. This impact has wide-reaching effects. Moreover, a fast-paced ED presents a host of challenges with competing priorities. In addition, EDs are perceived as 24/7 portals where rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients [3]. Blood culture contaminants are common, and they have a significant impact on patients and staff, contributing to unnecessary or inappropriate antibiotic treatment, increased length of stay, and costly economic burden [4]. The aim of this study was to evaluate the use of an automated blood culture collection system when drawing blood cultures from a peripheral IV and to evaluate the effectiveness of implementing evidence-based policies, procedures, practice, products, and patient care to reduce blood culture contamination rates.

A Quality Improvement Initiative to Reduce Blood Culture Contamination in the Neonatal Unit.

The QI team focused on standardizing processes to align with best practices using process mapping and cause and effect diagrams. Plan-Do-Study-Act (PDSA) 1: inoculation of blood culture bottles with the introduction of transfer device; PDSA 2: preparation of the skin for peripheral intravenous cannula insertion; PDSA 3: aseptic technique education package; and PDSA 4: optimizing blood volume of blood collected for culture. The team used statistical process control methodology to detect special cause variation. Compliance with the standard processes as part of PSDA 1 improved from a mean level of 50% to 100% and for PDSA 2 improved from a mean level of 50% to 95%. After implementation of PDSA 3, scores on a relevant knowledge test increased from a mean of 39% (pretraining test; n = 10) to 92% (posttraining test; n = 10) (P < 0.001). Postimplementation of the processes for PDSA 4, a minimum of 1 mL was collected in 94% of blood culture collection events (n = 450) (mean 1.1 mL; range 0.5-3.5 mL). Special cause variation occurred after the implementation of the PDSA cycles. During the baseline period, the BCC rate was 2.0% and decreased to 1.0% postinterventions implementation. Interventions focused on standardizing practices around collection of blood cultures in neonates were associated with fewer contaminants.This study is reported according to the SQUIRE 2.0 guidelines.

Asynchronous Testing of 2 Specimen-Diversion Devices to Reduce Blood Culture Contamination: A Single-Site Product Supply Quality Improvement Project

ObjectiveBlood culture contamination above the national threshold has been a consistent clinical issue in the ED setting. Two commercially available devices were examined that divert an initial small volume of the specimen before the collection of blood culture to reduce skin contamination. MethodsProspectively, 2 different blood culture–diversion devices were made available in the unit supplies to ED clinicians at a single site during 2 different periods of time as a follow-up strategy to an ongoing quality improvement project. Blood samples were collected in the emergency department over a period of 16 months. A retrospective record review study was conducted comparing the use of the 2 specimen-diversion devices with no device (control group) for blood culture contamination rates. The main outcome of monthly blood culture contamination per device was tested using a Bayesian Poisson multilevel regression model. ResultsA total of 4030 blood samples were collected and analyzed from November 2017 to February 2019. The model estimated that the mean incidence of contaminated blood draws in the device A group was 0.29 (0.14-0.55) times the incidence of contaminated draws in the control group. The mean incidence of contaminated blood draws in the device B group was 0.23 (0.13-0.37) times the incidence of contaminated draws in the control group, suggesting that initial-diversion methods reduced blood culture contamination. ConclusionInitial specimen–diversion devices supplement present standard phlebotomy protocols to bring down the blood culture contamination rate.