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

Abstract

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 patient management. This can prolong patient hospitalisation, increase the risk of harm and increase cost to health boards. Current guidelines advocate a contamination rate of 2–3%. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. A Quality Improvement team was created to try to reduce contamination rates to the recommended target.An initial baseline survey of local staff showed good understanding of when to obtain a blood culture but there was variability in the methods and equipment used. A project was then conducted which focused on rationalising and standardising equipment and technique for blood culture sampling along with staff education to support this change. A simple department target of 30 days free from a contaminated blood culture was created which, if achieved, would ensure a contamination rate of less than 3%. This was supported by ongoing surveillance of contamination rates and investigation of contaminated sample cases. We were able to then identify high risk patients and factors which increased the chance of blood culture contamination. This allowed us to formulate solutions to help reduce the risks of contamination. Department achievements and learning points to help prevent further contamination were fed back positively to all staff. This project operated for 12-months and successfully reduced local contamination rates to 2.0%.

Blood culture contamination in a tertiary care hospital of Saudi Arabia

“…18 Use of sterile blood culture systems such as BD Vacutainer, Push Button BC Collection kit, BacT/ ALERT adapter, cap and insert (Biomérieux) or BacT/ ALERT® BC bottles have been reported to significantly lower the contamination rate. 19 Inadequate volumes of blood for culture and the sequential drawing of blood when it is to be used for multiple laboratory tests, also adversely impacts the contamination rate. 6 Other exogenous risk factors contributing to neonatal sepsis and BCC that have been identified in premature and low birth weight infants, include the increased length of hospitalization in neonatal ICU, surgical procedures, parenteral nutrition, and use of invasive devices such as mechanical ventilation and central venous catheters.…”

Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts

“…The use of sterile gloves is not strictly necessary, although it could be considered depending on the institution's contamination rate [16]. Even after good hand hygiene and wearing gloves, the vein must not be re-palpated after skin antisepsis and before puncture [17]. -As a general rule, peripheral venipuncture is the method of choice for BC collection.…”

“…However, there are clinical situations in which access to a peripheral vein may be difficult; this may be particularly evident in critically ill and often edematous patients in the intensive care unit (ICU), for whom peripheral phlebotomy is challenging [22][23][24]. Although discouraged, this method can be accepted when venous catheter sampling is performed from a freshly placed cannula [17]. One exception is the diagnosis of central line-associated BSI; most current guidelines recommend simultaneous sampling of two BC sets, one collected from the catheter and the other through a, possibly contralateral, venipuncture to be able to estimate the differential time to positive BC or different microbial load [25][26][27].…”

Are current clinical guidelines on the use of Peripheral Intravenous Cannula for blood draws supported by evidence? An organizational case study

“…Peripheral intravenous cannula is the most commonly inserted vascular access device and can be used for administration of medications, blood sampling and management of conditions (Carr et al., 2016). Health professionals understand the importance of obtaining accurate blood sampling; however, there is considerable variability in the methods used (Bentley, Thakore, Muir, Baird, & Lee, 2016). Traditionally, most blood samples have been drawn from peripheral venepuncture, although increasingly PIVCs are being used for blood sampling (Carr et al., 2016; Davies, Coventry, Jacob, Stoneman, & Jacob, 2019).…”