Background: Blood culture contamination (BCC) increases length of stay (LOS) and leads to unnecessary antimicrobial therapy and/or hospital-acquired conditions (HACs). Aim: To quantify the magnitude of additional LOS, costs to hospitals and society, and harm to patients attributable to BCC. Methods: A retrospective matched survival analysis was performed involving hospitalized patients with septicaemia-compatible symptoms. BCC costs, HACs and potential savings were calculated based on the primary LOS data, a modified Delphi process and published sources. The cost analysis compared standard care with interventions for reducing BCC, and estimated annual economic and clinical consequences for a typical hospital and for the USA as a whole. Findings: Patients with BCC experienced a mean increase in LOS of 2.35 days (P¼0.0076). Avoiding BCC would decrease costs by $6463 [$4818 from inpatient care (53% of which was from reduced LOS) and 26% from reduced antibiotic use]. Annually, in a typical 250-to 400bed hospital, employing phlebotomists would save $1.3 million and prevent 24 HACs (including two cases of Clostridium difficile infection); based on clinical efficacy evidence, use of the studied initial specimen diversion device (ISDD) would save $1.9 million and prevent 34 HACs (including three cases of C. difficile infection). In the USA, the respective strategies would prevent 69,300 and 102,900 HACs (including 6000 and 8900 cases of C. difficile infection) and save $5 and $7.5 billion. Conclusion: Costs and clinical burdens associated with false-positive cultures are substantial and can be reduced by available interventions, including phlebotomists and use of ISDD.
We hypothesized that diversion of the first milliliter of venipuncture blood-the initial specimen diversion technique (ISDT)-would eliminate incompletely sterilized fragments of skin from the culture specimen and significantly reduce our blood culture contamination rate (R). We studied our hypothesis prospectively beginning with our control culture (C) definition: one venipuncture with two sequentially obtained specimens, 10 ml each, the first specimen (M1) for aerobic and the second (M2) for anaerobic media. The test ISDT culture (D) was identical, with the exception that each was preceded by diverting a 1-ml sample (D S ) from the same venipuncture. During the first of two sequential 9-month periods, we captured D versus C data (n ؍ 3,733), where D MX R and C MX R are R for D and C specimens. Our hypothesis predicted D S would divert soiled skin fragments from D M1 , and therefore, C M1 R would be significantly greater than D M1 R. ; P ؍ 0.50). We conclude that our hypothesis is valid: venipuncture needles soil blood culture specimens with unsterilized skin fragments and increase R, and ISDT significantly reduces R from venipuncture-obtained blood culture specimens.As a clinical laboratory test, blood culture has played a major diagnostic role in medicine for decades. One limitation of this diagnostic role is false-positive results, which increase expenses and have an adverse patient safety impact (1, 2). Consequently, numerous interventions with blood culture processes have been employed by laboratories to reduce contamination (5, 6). The purpose of this report is to introduce a new blood culture technique that significantly reduced the blood culture contamination rate (R) in this study. This innovation, the initial specimen diversion technique (ISDT), omits the first approximately 1-ml portion of venipuncture blood from the culture specimen without compromising or diminishing the volume of blood optimum for culture. The basis for ISDT is the hypothesis that skin fragments incompletely sterilized by skin surface antisepsis and dislodged by venipuncture increase R. We evaluated our hypothesis prospectively first with test ISDT versus control cultures for a 9-month period (group 1; n ϭ 3,733 cultures). Next, we collected data for a second 9-month period with an all-cultures ISDT (group 2; n ϭ 4,143) for comparison to test ISDT. MATERIALS AND METHODSPatients and phlebotomists. The blood cultures in this study were from adults suspected of having sepsis who were hospitalized, evaluated in the emergency room, or seen as outpatients in a not-for-profit urban community hospital setting. Venipunctures (peripheral vein sites only) were performed by laboratory-trained and supervised phlebotomists who wore safety gloves during the procedure. No indwelling-catheter-obtained specimens were included in this study. Our standard procedure of monitoring needle puncture and other laboratory staff issues was continued during and after the study.Skin preparation. Prior to venipuncture, the skin antisepsis agent 2% chlorhexid...
Benign disease and invasive cancer of the breast can be diagnosed with a high level of confidence using image-guided LCNB. The histologic diagnosis for patients whose LCNB specimens show ADH or DCIS may change after excision.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.