Reducing Blood Culture Contamination Rates Research Articles

Reducing Blood Culture Contamination Rates: Experiences of Four Hospital Systems.

IntroductionBlood cultures (BCs) frequently become contaminated during the pre-analytic phase of collection leading to downstream ramifications. We present a summary of performance improvement (PI) interventions provided by four hospital systems and common factors that contributed to decreased blood culture contamination (BCC) rates.MethodsEach hospital independently formed a multidisciplinary team and action plan for implementation of their intervention, focusing on the use of educational and training tools. Their goal was to significantly decrease their BCC rates. Pre- and post-intervention data were compared during the sustainment period to determine their success.ResultsAll hospitals met their goals of post-intervention BCC rates and with most achieving and sustaining BCC rates ≤ 1.0–2.0%.ConclusionOur report highlights how four hospitals independently achieved their objective to decrease their BCC rate with the support of a multidisciplinary team. We propose a benchmark for BCC rates of 1.5 to < 2.0% as achievable and sustainable.

A Study in Reducing Blood Culture Contamination Rates

A Study in Reducing Blood Culture Contamination Rates

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.

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

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...

Reducing blood culture contamination rates: A systematic approach to improving quality of care

Contaminated blood cultures can have a deleterious effect on patient care; they may lead to longer hospital stays, unnecessary antibiotic therapy, needless removal of central lines, and redundant laboratory testing. A multidisciplinary quality improvement team from a western US health care system used an evidence-based process to define a system for obtaining blood culture specimens that subsequently decreased contamination rates from 3.7% to 1.7% with an estimated savings close to 2 million dollars in 2 years.

A Randomized Controlled Trial of 1% Aqueous Chlorhexidine Gluconate Compared with 10% Povidone-Iodine for Topical Antiseptic in Neonates Effects on Blood Culture Contamination Rates

We conducted a randomized controlled trial in neonates with birth weight greater than or equal to 1,500 g that compared 1% aqueous chlorhexidine gluconate (CHG) with 10% povidone-iodine (PI) as a topical antiseptic. We found 1% CHG to be more effective than 1% PI in reducing blood culture contamination rates, and no contact dermatitis was observed.

Blood Culture Contamination A Clinical and Financial Burden

Affiliation: 1. Clinical Microbiology-Immunology Laboratories and Phlebotomy Services, University of North Carolina Hospitals, Chapel Hill, North Carolina; and University of North Carolina School of Medicine, Chapel Hill, North Carolina. Received September 20, 2012; accepted September 20, 2012; electronically published November 26, 2012. 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2013/3401-0003$15.00. DOI: 10.1086/668771 The study by Washer et al in this issue of the journal reminds us of the clinical and financial burden that contaminated blood cultures represent. Washer and colleagues ask a fairly simple question: of the 3 antiseptics most widely used to cleanse venipuncture sites prior to collection of blood for culture, which results in the lowest rate of contaminated blood cultures? The answer that none is superior is consistent with a recent Centers for Disease Control and Prevention (CDC) Laboratory Best Practices Guideline on practices that reduce blood culture contamination. Besides the finding that the type of antiseptic used does not influence blood culture contamination rates, 2 other practices are associated with reduced blood culture contamination rates: having blood cultures drawn by phlebotomists whose main duty is drawing blood and having blood drawn by venipuncture rather than from intravenous catheters are strongly associated with reduced rates of contamination. The finding that the type of disinfectant used does not influence the contamination rate may be at odds with the results of some previous studies, but the CDC’s systematic review of the data suggests otherwise. One of the key strengths of the study by Washer and colleagues is the use of a dedicated phlebotomy team. It is likely that training a small group of individuals to properly apply antiseptics with different dwell times contributes to the impressively low contamination rate of less than 1% regardless of antiseptic used. This rate is superior to that reported in many studies and is significantly below the American Society for Microbiology’s and College of American Pathologists’ benchmark for contaminated blood cultures, which is between 2.5% and 3%. Why are rates lower for phlebotomists than for other healthcare providers? Simply put, it is because of training, practice, resources, and professionalism. At our institution, phlebotomists routinely have a monthly blood culture contamination rate of less than 1%, as was seen in the study of Washer and colleagues. The training they receive includes one-on-one instruction by a senior phlebotomist during their initial series of blood culture collection and retraining if their individual contamination rates rise above 2%. This is not done with any other healthcare provider in a systematic manner in our institution. Phlebotomists draw the bulk of blood cultures obtained by venipuncture, so they are more practiced at this method. This is particularly key when drawing blood cultures from patients with poor venous access, who may require venipuncture of hand or foot veins, something that trained phlebotomists are comfortable doing, whereas many other healthcare providers are not. Phlebotomists also have all the supplies at hand on individual carts that travel with them, unlike other professionals, who may have to scrounge around for appropriate supplies. Finally, they take great pride in having contamination rates that are lower than those of any other professional who draws blood cultures at our institution. It is a benchmark of their worth to the institution, something of which they are well aware. Why is reducing blood culture contamination rates important? Simply put, contaminated blood cultures are expensive and put patients at risk for significant iatrogenic complications. The seminal work by Bates et al was the first to quantify the cost of a contaminated blood culture, at $4,500. This cost was due to increased length of stay, typically of 1 day; use of unnecessary antimicrobial therapy; and diagnostic testing. Subsequent studies have put this cost as high as $10,000. Let us use an illustration to understand the annual cost of contaminated blood cultures. Say that hospital A does 20,000 blood cultures annually and has a 2.5% contamination rate, while hospital B does 30,000 with a 1% contamination rate. The cost of a contaminated blood culture at each institution is $5,000. Hospital A, even though it does two-thirds the number of blood cultures, has an annual excess expense due to contaminated blood cultures of $2,500,000, while hospital B has a cost of $1,500,000. In addition, hospital A has 200 more hospital-days when a bed is not available compared with hospital B because of the increased length of stay of 1 day. In hospitals that have a chronic shortage of beds, those extra 200 hospital bed–days would be highly useful. The clinical impact of contaminated blood cultures is also

Reducing Blood Culture Contamination Rates in the Emergency Department

Routine monthly monitoring of blood culture (BC) contamination rates detected a spike (>3%) in false-positive BCs drawn in the emergency department. This triggered an ad hoc quality-improvement team to develop and implement a corrective action plan in our 230-bed urban community hospital with 58,000 ED visits annually. Both phlebotomists and nurses draw BCs in the emergency department; therefore all interventions were directed at both groups. These included private conversations with individual staff members associated with higher numbers of contaminated draws compared with peers, ensuring availability of necessary BC collection supplies, re-education of all phlebotomists and ED nursing staff surrounding BC collection best practices, monthly feedback to staff on BC contamination rates, and continuing private conversations as necessary, regardless of the contamination rate. Before the spike in the emergency department, the average rate of BC contamination for the hospital as a whole was 1.82% (January-July 2011). Excluding 3 months when ED contamination was greater than 3% and the hospital contamination rate was 2.65% (August-October 2011), the average rate of BC contamination for the hospital dropped to 1.01% after the interventions (November 2011-June 2012). This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. The total hospital BC contamination rate never rose above the 3% benchmark, which illustrates the importance of tracking ED-specific data.

Effective strategy for decreasing blood culture contamination rates: the experience of a veterans affairs medical centre

Contaminated blood cultures constitute diagnostic challenges and place a burden on healthcare services. An observational retrospective study was undertaken to evaluate the effect of routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, on blood culture contamination rates. The contamination rate of the entire facility was 2.6% before the procedural change, and this decreased significantly to 1.5% after the procedural change (P<0.001) over the first 12 months of the intervention. Routine labelling of blood culture bottles with the initials of the healthcare worker who drew them, followed by individualized feedback, was effective in reducing blood culture contamination rates.

Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis

This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits. The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12). Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement.

Reducing Blood Culture Contamination Rates by Educational Intervention and one-on-one Feedback in the Emergency Department

Background/Purpose Blood culture specimens collected from patients in the emergency department (ED) can subsequently give the clinical physicians useful information and references for diagnosis and medication selection. If the isolates are found to be contaminants, the consequences are increased antibiotic use and inpatient hospital fees. The purpose of this research is to reduce blood culture contamination (BCC) rates in the ED. Methods The effectiveness of educational intervention and one-on-one feedback to reduce BCC rates in the ED was assessed in a busy medical center in which blood cultures were obtained by nurses rather than trained phlebotomists. The study comprised two phases. The first phase was to ensure understanding of the correct methods for performing blood culture, and to measure the effectiveness of the educational intervention. The second phase was to continue the educational intervention plus to give one-on-one feedback of the BCC rates to the ED and individuals weekly. Results The baseline BCC rate was 3.4% in the pre-intervention period. The BCC rate fell to 2.67% in Phase 1 (i.e., educational intervention only). The BCC rate fell to 2% in Phase 2 (i.e., educational intervention plus one-on-one feedback). Among the contaminants, coagulase-negative staphylococci (CoNS) fell from 62% before the intervention to 48% post-intervention. Conclusion Educational intervention plus one-on-one feedback for decreasing BCC rates was more effective than an educational intervention alone in our study.