Reducing Blood Culture Contamination Research Articles

Impact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of laboratory medicine

Introduction: Blood cultures play a very important role in the diagnostic algorithm for managing patients with sepsis. Contamination of blood cultures complicate patient care resulting in unnecessary antibiotic use, prolonged hospital stays and more financial burden on the patient. Hence, microbiology laboratories strive to keep contamination rates within <3% as per international standards. Aim: To monitor blood culture contamination rate and reduce contamination using a novel blood culture collection (BCC) bundle. Materials and Methods: A prospective interventional study carried out in a newly set up Microbiology laboratory of a 200 bed tertiary care hospital in North Mumbai. Blood cultures from various clinical areas of the hospital were processed using the BacT/Alert system (BioMereiux, Marcy l'etiole, France). All positive blood cultures were co-related clinically and assigned as pathogens or contaminants. Blood culture contamination rates were actively monitored and BCC bundle was introduced to reduce contamination, which comprised six steps to follow while performing BCC. Active surveillance, audits of the collection process and root cause analysis (RCA) of blood culture contamination were done simultaneously. This was followed by feedback to phlebotomists, nurses and doctors. Periodic and need-based onsite training of health-care workers was also done. Results: Different types of Health Care Workers were performing the procedure. The most common contaminant grown were Gram-positive cocci 159 (25.5%), followed by Gram-negative bacilli 58 (9.32%), and Bacillus spp. 37 (5.95%). It was observed that skin disinfection and incorrect order of draw were two main reasons for the contamination. Over a period of 18 months, BCC bundle implementation reduced the contamination from 17% to 4%. Conclusion: RCA, training, surveillance and audits are essential to improve the quality of blood culture results. Implementation of the BCC bundle benefits both the microbiology laboratory and the clinical teams by decreasing the growth of contaminants and improving the utility of blood culture for better management of patients in sepsis bringing in favorable outcomes.

Improvement of blood culture contamination rate, blood volume, and true positive rate after introducing a dedicated phlebotomy team.

The introduction of dedicated phlebotomy teams certified for blood collection has been reported to be highly cost-effective by reducing contamination rates. However, data on their effects on blood volume and true positive rate are limited. Therefore, we investigated the effect of replacing interns with a phlebotomy team on blood culture results. We performed a 24-month retrospective, quasi-experimental study before and after the introduction of a phlebotomy team dedicated to collecting blood cultures in a 2700-bed tertiary-care hospital. The microbiology laboratory database was used to identify adult patients with positive blood culture results. During the study period, there were no changes in blood collection method, blood culture tubes, and the application of antiseptic measures. Blood volume was measured by the BACTEC™ FX system based on red blood cell metabolism. A total of 162,207 blood cultures from 23,563 patients were analyzed, comprising 78,673 blood cultures during the intern period and 83,534 during the phlebotomy team period. Blood volume increased from a mean of 2.1ml in the intern period to a mean of 5.6ml in the phlebotomy team period (p < 0.001). Introduction of the phlebotomy team also reduced contamination rate (0.27% vs. 0.45%, p < 0.001) and led to a higher true positive rate (5.87% vs. 5.01%, p < 0.05). The increased true positive rate associated with the phlebotomy team involved both gram-positive and gram-negative bacteria. The introduction of a dedicated phlebotomy team can increase blood volumes, reduce blood culture contamination rate, and increase true positive rate.

The effectiveness of interventions to reduce peripheral blood culture contamination in acute care: a systematic review protocol

BackgroundBlood cultures are an integral part of the diagnosis of bacteremia in unwell patients. The treatment of bacteremia involves the rapid and accurate identification of the causative agent grown from the blood cultures collected. Contamination of blood cultures with non-pathogenic microbes such as skin commensals causes false positive results and subsequent unnecessary and potentially harmful interventions. While guidelines for blood culture quality recommend no more than 2–3% contamination rate, rates up to 12% are reported in the literature. There have been a number of methods proposed to reduce the contamination of blood cultures, including educational interventions, changing of skin cleansing preparations and introduction of blood culture collection packs in acute care settings. This protocol outlines methods to identify and evaluate interventions to reduce blood culture contamination in the acute care setting.MethodsThe reviewers will conduct a systematic search of literature in CINHAL, PubMed, EMBASE and the Cochrane Central register of controlled trials. Unpublished works will be identified in ProQuest Dissertations and Theses. Articles will be assessed for relevance based on their title and abstract. Remaining relevant citations will have their full text retrieved and assessed against eligibility criteria. All studies that meet the eligibility criteria will have their methodological quality appraised. Assessments for relevance and methodological quality will be conducted independently by two reviewers. If appropriate, data will be analysed using the Mantel-Haenszel method under a random effects model. Heterogeneity of the studies will be assessed using the I2 and chi-squared statistic. Meta-analysis will be attempted if the data is suitable.DiscussionThis review will identify and summarise the interventions previously described in the literature aimed at reducing peripherally collected blood culture contamination rates in acute care. These findings have the potential to lead to multifaceted interventions based on previous evidence to reduce blood culture contamination in the acute setting. Reductions in the proportion of contaminated blood cultures have the potential to save money, unrequired treatment (particularly antimicrobials) and hospital bed days.Systematic review registrationIn accordance with guidelines outlined in the PRISMA-P methodology, this protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on December 8, 2017, and last updated on January 4, 2018 (registration number CRD42017081650).

240. Estimated Clinical and Economic Impact Through Use of an Initial Specimen Diversion Device to Reduce Blood Culture Contamination: A Cost–benefit Analysis

BackgroundBlood culture contamination results in increased hospital costs and unnecessary patient-exposure to antimicrobials. We sought to evaluate the potential clinical and economic benefits of a novel blood culture diversion device when routinely utilized for blood culture collection in the emergency department (ED) of a quaternary care medical center.MethodsA decision analysis model was created. Probabilistic costs were determined from published literature and direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) after initial specimen diversion device (e.g., SteriPath) implementation in the ED using a hospital perspective. Indirect hospital costs included increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created for hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures.ResultsThe routine implementation of an initial specimen diversion device for blood culture collection in the ED was cost-beneficial compared with conventional blood culture collection methods and was also associated with a reduction in antibiotic usage, adverse drug reactions and hospital-acquired infections. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, initial specimen diversion device use was associated with a cost savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. Main drivers of cost included the baseline rate of contamination in the ED and the duration of antibiotics given to patients with negative blood cultures.ConclusionImplementation of an initial specimen diversion device is estimated to be a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy, and wider indirect hospital costs.Disclosures K. W. Garey, Merck & Co.: Grant Investigator, Grant recipient.

A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children's Hospital.

Blood culture contamination is a safety and quality concern in children's hospitals; it leads to increased unnecessary testing, admissions, antibiotic exposure, and cost. The standard benchmark for blood culture contamination is 3%. Our aim with the quality improvement project was to reduce the contamination rate at our children's hospital from a mean of 2.85% to <1.5% in 2 years. After initial unit-specific efforts, we formed a multidisciplinary team, created a process map and a cause-and-effect analysis, sent out surveys to nurses, and created observation sheets used to identify problem areas and record the most common deviations during the collection process. We also standardized the blood culture collection protocol and reemphasized nurse education in person and with online modules. During our project, we noted that nurses were collecting 1 to 3 mL of blood on all children regardless of weight. We developed optimal weight-based blood volumes and, after educating ordering providers, we updated our electronic medical record to reflect appropriate volumes in the order. Despite a steady increase in the number of blood cultures collected at our children's hospital, we were able to decrease the average contamination rate from 2.85% to 1.54%, saving the hospital an estimated average of $49 998 per month. By standardizing blood culture collection methods, optimizing blood volume, creating checklists, and reinforcing nurse education, we were able to develop a best practice for pediatric blood culture collection and reduce blood culture contamination to a sustainable low rate at our children's hospital.

Reducing Blood Culture Contamination Rates in the Emergency Department

Rate of contamination is a well-known indicator of quality of care in the emergency department. Blood-culture results may affect clinical decision making. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. Using a quality improvement strategy, this project aimed to (1) identify potential factors contributing to the high blood culture contamination rate and (2) achieve a blood culture contamination rate below 3%. The factors that were identified as potentially contributing to the high blood culture contamination rate were: (a) Nursing staff: lack of related education and training and ignorance of related clinical guidelines; (b) The system: inconsistent and non-evidence-based clinical guidelines (e.g., no requirement to use sterile gloves when obtaining blood cultures and changing disinfectants); (c) The patient: older patients, residents of long-term care facility, and patients whose blood culture were in the first set were associated with higher blood culture contamination rates. Our quality improvement strategy included: design a new bedside working plate, develop slogans and posters illustrating the proper blood-drawing procedure, make a video introducing current standard technology, provide continuing education, monitor contamination rates, and provide individual feedback and retraining for those with higher contamination rates. The strategy was implemented from October 1, 2016 to December 31, 2016, during which period the blood culture contamination rate reduced from 5.63% to 1.51%. Conclusion: Improving equipment, using multiple teaching methods, and providing regular feedback not only significantly reduced the blood culture contamination rate but also enhanced the knowledge and skills of nursing staff in terms of blood culture sampling. We hope that our results are referenced by other nursing departments and used to improve the blood culture contamination rates in other clinical settings.

EC-90 - Reducing Blood Culture Contamination by an Educational Intervention with a Simple Procedure Sheet at an Acute Care Hospital

Background: Blood culture (BC) is important in the medical treatment of infectious diseases and provision of medical care. Erroneous blood culture leads to inappropriate use of antibacterial medicine. At an acute care hospital (600 beds) in middle of Japan, until 2010 BC contamination rate had been higher than 3.0%. In 2010 BC's blood collection procedure was reviewed and then education was carried out using that procedure every year. So we examined whether the quality of BC was improved.

Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates

ProblemFalse-positive blood-culture results due to skin contamination of samples remain a persistent problem for health care providers. Our health system recognized that our rates of contamination across the 4 emergency department campuses were above the national average. MethodsA unique specimen collection system was implemented throughout the 4 emergency departments and became the mandatory way to collect adult blood cultures. The microbiology laboratory reported contamination rates weekly to manage potential problems; 7 months of data are presented here. ResultsThere was an 82.8% reduction in false positives with the unique specimen collection system compared with the standard method (chi-squared test with Yates correction, 2-tailed, P = 0.0001). Based on the historical 3.52% rate of blood-culture contamination for our health facilities, 2.92 false positives were prevented for every 100 blood cultures drawn, resulting from adoption of the unique specimen collection system as the standard of care. ConclusionThis unique collection system can reduce the risk of blood culture contamination significantly and is designed to augment, rather than replace, the standard phlebotomy protocol already in use in most health care settings.Unlabelled Box

1-106 - Reduction of Blood Culture Contamination Rate for a 300 Bed Community Hospital

BACKGROUND: Blood culture contamination is a serious patient safety risk that can result in unnecessary antibiotic administration, increased cost to the patient, and prolong hospital stays. The hospital experienced a steady increase in blood culture contamination rates for 2012 and 2013, 2.36% and 2.84% respectively. The benchmark was set at ≤2%. The purpose of this project was to reduce blood culture contamination rate for the hospital.

Reducing Blood Culture Contaminations in the Emergency Department: It Takes a Team

Healthcare providers rely heavily on blood culture results for developing the patient's plan of care. Contaminated blood cultures can lead to unnecessary treatment, unnecessary hospitalization, and an increase in the patient's length of stay. There was a significant increase in our monthly blood culture contamination rates, over a 3 month period of time, which exceeded a recommended standard of <3%, as high as 4.35%. Given the negative impact this could have on patient outcomes, a quality improvement project was developed in order to ensure delivery of the highest quality of care. We reviewed the literature to identify best practices related to blood culture specimen collection and incorporated strategies that proved to be effective in overcoming barriers similar to ours. We also used strategies that were tailored to meet our specific needs. Our plan included targeting environmental and skin contaminates, teamwork, education and feedback. During the 8 week pilot, the monthly contamination rates were 1.96% and 0.3%, respectively. Subsequent data over 1 year revealed the contamination rates ranged from 0.2% to 1.51%, with a mean of 0.87%. The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. The commitment from our team was considered the most valuable asset and strategy. Developing a plan that is evidence-based and feasible in the fast paced Emergency Department can help ensure the delivery of high quality care.

A change of culture: reducing blood culture contamination rates in an Emergency Department

Blood cultures are an important investigation to help tailor effective management for patients with severe sepsis. Frequent contaminated samples increase laboratory workload and can delay or cause incorrect changes to...

Educational intervention as an effective step for reducing blood culture contamination: a prospective cohort study

Contaminated blood cultures lead to diagnostic challenges and place a burden on healthcare services. To determine the impact of introducing a clinical skills test (CST) as part of the medical licensing examination and an institutional education programme on the contamination rates of blood cultures. A prospective cohort study was conducted from 2009 through 2013 in all wards of a tertiary-care teaching hospital. We evaluated the effects of the CST, which was added to the National Medical Licensing Examination in Korea (KMLE) in 2010 and our institutional education programme, which began in 2013. The medical interns in charge of collection of blood for culture were divided in three groups with presence or absence of CST and the institutional education programme. The primary outcome was the percentage of blood cultures contaminated in each group, which were compared using the Poisson regression model. Participants' self-rated scores for the blood draw procedure were also analysed. Although introduction of the CST in the KMLE failed to reduce blood culture contamination rate (1.36% vs 1.35%; P = 0.734), the institutional education programme significantly reduced the contamination rate (1.35% vs 1.00%; P < 0.0001). Most participants answered that they always followed each step correctly except for waiting the recommended contact time after applying the antiseptic. The educational intervention, not the introduction of CST in the KMLE, was effective in reducing overall contamination rates.

Reducing blood culture contamination in the emergency department effects by alcoholic chlorhexidine as anti-septic agents

Reducing blood culture contamination in the emergency department effects by alcoholic chlorhexidine as anti-septic agents

Reducing blood culture contamination for guality improvement methodologies

Reducing blood culture contamination for guality improvement methodologies

Using Lean Management to Reduce Blood Culture Contamination

Blood culture contamination (BCC) is a common and avoidable complication of patient care and incurs considerable cost. A quality improvement (QI) initiative was undertaken at a large Department of Veterans Affairs (VA) medical center to reduce the BCC rate. Lean management QI methods, including a rapid process improvement workshop (RPIW), were used to identify root causes of variation in blood culture procedures and countermeasures (potential improvement strategies) to address each problem were developed. BCC rates were collected for five and one quarter years, including the pre-RPIW (baseline) period, and changes in the contamination rates were calculated. The observed change in BCC rates was compared to a forecast of the pre-RPIW trend and estimated BCCs avoided. Results for the primary medical center were compared with those of a similarly complex VA medical center during the same time periods using difference-in-differences methodology. Qualitative assessment of the processes of care identified four root cause problems, each of which was addressed with countermeasures. The BCC rate at the primary medical center decreased significantly from the baseline period in each year of follow-up, improving from 4.2% in the 19-month baseline period to 2.8% in the last 12 months of follow-up (April 2013-March 2014), while changes from baseline in the BCC rate at the comparison site were significant in only one year of follow-up. An estimated 261 BCCs were avoided at the primary medical center in the follow-up period. The QI initiative was successful in reducing BCC rates and in producing continued improvement for nearly four years of follow-up. Further study will determine if these results are generalizable to other settings.

The effect of a quality improvement programme reducing blood culture contamination on the detection of bloodstream infection in an emergency department

Contaminated blood cultures (BC) generate avoidable costs and prolong hospital stays. To measure our hospital's performance against the recommended standard of <3% BC contamination, we performed a prospective study. We prospectively determined the frequency of contaminated and genuinely positive BC hospital-wide over seven months. Overall, 73 of 1,829 blood cultures reviewed were contaminated (4.0%). However, distribution of contamination was not uniform. Finding a consistently higher incidence of contamination (11.7%) in our emergency department (ED) than elsewhere in the hospital (2.5%), we adopted a collaborative quality improvement strategy targeted to the ED. A combination of education, modified BC packs and regular feedback of BC results was associated with a significant reduction in contamination (7.4%, p=0.01) over the next six months. Our data suggests that contaminated BC were more likely to have been taken during regular day time hours (odds ratio (OR) 2.7, p=0.012), rather than overnight and were not associated with influxes of new junior medical staff. We found no evidence that the incidence of true bloodstream infection (12.8%) diagnosed by our ED was adversely affected by our intervention (10.7%, p=0.35). Using a simple and inexpensive collaborative intervention we reduced BC contamination without adversely affecting the detection of genuine BSI.

Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial.

To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization. Pragmatic cluster-randomized trial. Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals. Patients admitted to adult ICUs from July 1, 2009, to September 30, 2011. After a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms. During the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1, 2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71). In this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.

Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams.

Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams. Cost analysis. This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated). Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses. EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

PC.23 Blood Culture Contamination in Neonates

BackgroundBlood culture contamination can have many negative effects including unnecessary treatments, costs and contribution to antibiotic resistance. Neonates are often treated on the basis of a single blood culture result,...

Grass Roots Education to Reduce Blood Culture Contamination Rates

ISSUE: Increased surveillance requirements and overall workload of Infection Preventionists (IPs) prompted purchase of data mining software to reduce time spent on surveillance-related work and increase time spent on unit rounding and special projects. A survey was completed to assess time management changes. PROJECT: Using the Results of a 2009 survey (pre-data mining software) as a baseline, a survey was sent to all IPs one year after implementation of TheraDoc Clinical Surveillance System. The survey was designed to assess time spent accessing numerator and denominator data on SSI, CLABSI, CAUTI, VAP, MDRO, CDI and miscellaneous surveillance. IPs were asked to assess how frequently they viewed or created rates and benchmarks for the infections listed. Results were compared to the 2009 data and percent differences calculated. An additional question asked about changes in how data is shared and communicated with others outside the IP department. RESULTS: Table 1 Frequency of access of weekly data increased dramatically from pre to post for numerator/denominator data (+57.6%) and viewing/creating rates and benchmarks (+478.3%). Access of monthly numerator and denominator data increased 9.5%. The frequency at which quarterly data was retrieved decreased for both measures. The frequency at which IPs created or viewed rates or benchmarks decreased on a monthly basis (-11.6%). (Table 2). Majority of IPs saw increase in sharing data and communication with outside departments. LESSON LEARNED: Implementation of data mining software dramatically increased accessibility of infection control data, decreasing time spent creating/recreating infection rates, graphs, and benchmarks. As a result, IPs increased data sharing with hospital units and leaders, and increased communication with outside departments. As the IPs continue to evolve their use of the software and the capabilities of the software are enhanced, IPs’ ability to add value beyond their department will continue to grow, even with increased surveillance requirements.