A simplified blood culture sampling protocol for reducing contamination and costs: a randomized controlled trial

Abstract

Objectives: Blood culture contamination carries risks for patients, such as unnecessary antimicrobial therapy and other additional hazards and costs. One method shown to be effective in reducing contamination is initial blood specimen diversion during collection. We hypothesized that initial blood specimen diversion without a designated device or procedure would suffice for reduction in blood culture contamination rate. Methods: From 1 September 2017 through to 6 September 2018, we conducted a randomized controlled trial to assess the effect of an initial-specimen diversion technique (ISDT) on the rate of blood-culture contamination by changing the order of sampling using regular vacuum specimen tubes instead of commercially available sterile diversion devices. We included adults from whom the treating physician planned to take blood cultures and additional blood chemistry tests. Additionally, we evaluated the potential economic benefits of an ISDT. This was a researcher-initiated trial, Clinicaltrials.gov NCT03088865. Results: In all, 756 patients were enrolled. This method, compared with the standard procedure in use at our medical centre, reduced contamination by 66% (95% CI 17%e86%), from 20/400 (5%) with the standard method to 6/356 (1.6%) with the ISDT, without compromising detection of true bloodstream infection and at no additional cost. Hospital-wide implementation of ISDT was associated with a 1.1% saving in hospitalization days. Conclusions: We offer this novel approach as a simple, cost-effective measure to reduce risks to patient safety from contaminated blood cultures, without the need for using costly devices.

Nanopore-Targeted Sequencing Improves the Diagnosis and Treatment of Patients with Serious Infections

“…However, as some bacteria and fungi are difficult to grow in culture, the sensitivity of these inspection techniques is unsatisfactory ( 3 ) and not fit for purpose for acute serious infections, such as sepsis in patients with a blood disease, especially those undergoing HSCT. Moreover, the times required for Gram staining, organism identification (ID), and antimicrobial susceptibility testing for blood cultures are 1 day, 2 days, and 3 days, respectively ( 4 , 5 ). The average turnaround time for anal swab samples, a common method for early detection of carbapenem-resistant Enterobacter (CRE) spp., is 2 to 4 days ( 6 ).…”

Blood Culture Contamination: A Single General Hospital Experience of 2-Year Retrospective Study

“…These results were much higher than the recommended target rate of 3% for BCC in adults [ 10 ]. Lalezari et al report that 50% of all positive blood cultures were found to contain contaminants [ 27 ]. Washer et al found 13% of all positive blood cultures appeared to be contaminated, and that overall blood contamination rates were 0.8% among cultures obtained peripherally by phlebotomists [ 19 ].…”

G-control Charts for Contamination Rates of Blood Cultures in a University Hospital

“…The chart then starts with the second CSN, and the NBP between the first and the second CSN. [7][8] We used median of total NBP to define the center line (CL), and used confidence intervals to define control limits of the chart. The confidence intervals were calculated using equations proposed by Yang Z et al 9 The equation for lower limit is ln(1 -α/2)/ln(q) and the equation for upper limit is ln(α/2)/ln(q)-1 ,where α is the cumulative probability and q is the probability of a non-contaminated specimens.…”