Objectives: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. Methods: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe.Results: There was a statistically significant reduction in the number of contaminants (p = 0.03). Conclusions: Simple measures to encourage skin disinfection and appropriate sampling technique will reduce the incidence of contamination of blood cultures in the A&E department.T he usefulness of blood cultures taken in the Accident and Emergency department (A&E) remains open to question. In two A&E based studies only 1.6% of blood cultures taken in one study had an impact on the management of patients 1 and in another only 0.52% potentially had their medical management affected by the positive blood culture results. 2Contamination of blood cultures is also a common problem and false positive results due to contaminants may lead to errors both in clinical interpretation and administration of inappropriate treatment. There are several problems in A&E which may contribute to high contamination rates of blood cultures-these include a rapid turnover of staff, lack of ongoing training, workload, and the nature of the presenting patients. Our study shows the effect that the provision of information on skin decontamination has on the contamination rate in A&E. METHODSThe infection control team, in partnership with the A&E consultant staff, introduced a blood culture sampling kit. This contained BacT/ALERT (Biomerieux, Basingstoke, Hants, UK) sampling bottles but the bottles were placed in a polythene sleeve with enclosed pocket size instructions on how to take blood cultures (fig 1) and a large 62% ethyl alcohol impregnated wipe (Purell, Gojo Industries, Arkon, OH, USA) for cleaning the patient's skin before venepuncture.The medical and nursing staff in A&E were instructed on how to use the blood culture kits but no additional formal training was given on venepuncture. The interventions were timed to occur in the middle of the junior doctors' rotation period to minimise the effect that staff changes may have had on the study.The request form was marked in order to allow the laboratory to identify which blood culture samples had been collected using the kit method. Bacteria were identified using standard microbiological techniques. A blood culture contaminant was defined as a usual skin organism that was isolated from only one set of blood cultures in a patient with no evidence of an infection with that organism. RESULTSIn the month before the intervention 50 sets of blood cultures were taken, 35 (70%) had no bacterial growth, three (6%) were judged to have significant growth, and 12 (24%) were judged to contain contaminants. In the month following the intervention 50 sets of blood cultures were also taken; 37 (74%) had no bacterial growth, nine (18%) were judged to have significant growth, and four (8%) were judged to con...

Level II-retrospective prognostic study.

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Documentation improved slightly following the intervention, but was still unsatisfactory. We believe that to achieve an adequate level of documentation in the medical record for an episode of intubation, there needs to be a formal and structured mechanism, either via mandatory use of a specifically designed form and/or by participation in an organized data registry.

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Our algorithm for managing bilateral femoral fractures prioritises early stabilisation with external fixation, staged intramedullary nailing and conversion to plate fixation if FES develops. This protocol is meant to be the basis of future investigations of optimal treatment strategies.

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