Blood Culture Contamination A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

Washer, Laraine; Chenoweth, Carol E.; Kim, Hae Won; Rogers, Mary A.M.; Malani, Anurag N.; Riddell, James; Kuhn, Latoya; Noeyack, Bernard; Neusius, Harry; Newton, Duane W.; Saint, Sanjay; Flanders, Scott A.

doi:10.1086/668777

Cited by 46 publications

(33 citation statements)

References 23 publications

(24 reference statements)

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“…This study corroborates and supports the recent findings of Washer et al (6). Similar to those investigators, we found virtually no difference in CRs between CH and IT.…”

Section: Discussionsupporting

confidence: 94%

“…The results of this study, as well as those of Washer et al (6), suggest that iodine tincture and chlorhexidine tincture are equivalent antiseptic agents for skin antisepsis in patients who require blood cultures. Therefore, other factors may be considered in the decision of which product to choose in a given institution.…”

Section: Discussionsupporting

confidence: 76%

“…Chlorhexidine (CH) and iodine tincture (IT) have been shown to be more effective than povidone iodine (PI) for reduction of contamination (4,5,6); however, no statistically significant difference has thus far been found to exist between CH and IT (6,7). A recent prospective randomized crossover trial reported by Washer et al (6) directly compared CRs between CH, IT, and PI as antisepsis methods.…”

mentioning

confidence: 99%

“…A recent prospective randomized crossover trial reported by Washer et al (6) directly compared CRs between CH, IT, and PI as antisepsis methods. They found no statistically significant difference between them; however, the overall CR for the study period was only 0.76%, which is considerably lower than the average CR at most medical centers across the United States (6). This low baseline CR may make significant differences between antisepsis methods difficult to distinguish.…”

mentioning

confidence: 99%

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Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Story-Roller

Weinstein

2016

J Clin Microbiol

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Blood cultures (BCs) are the standard method for diagnosis of bloodstream infections (BSIs). However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, potentially resulting in unnecessary antibiotic use and excessive therapy costs. Several studies have compared various skin antisepsis agents without a clear consensus as to which agent is most effective in reducing contamination. A prospective, randomized crossover study directly comparing blood culture contamination rates using chlorhexidine versus iodine tincture for skin antisepsis was performed at Robert Wood Johnson University Hospital (RWJUH). Eight nursing units at RWJUH were provided with blood culture kits containing either chlorhexidine (CH) or iodine tincture (IT) for skin antisepsis prior to all blood culture venipunctures, which were obtained by nurses or clinical care technicians. At quarterly intervals, the antiseptic agent used on each nursing unit was switched. Analyses of positive BCs were performed to distinguish true BSIs from contaminants. Of the 6,095 total BC sets obtained from the participating nursing units, 667 (10.94%) were positive and 238 (3.90%) were judged by the investigators to be contaminated. Of the 3,130 BCs obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of 2,965 BCs obtained using CH, 327 (11.03%) were positive and 115 (3.88%) were contaminated. The rates of contaminated BCs were not statistically significant between the two antiseptic agents (P ‫؍‬ 1.0). We conclude that CH and IT are equivalent agents for blood culture skin antisepsis. Blood cultures (BCs) have long been the standard method of diagnosis of bacteremia during hospitalization. However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, resulting in unnecessary antibiotic use and potential excessive therapy costs of Ͼ$8,000 per contamination event (1, 2). Studies have shown that the use of prepackaged antisepsis kits aid in reduction of contamination from 8.4% to 4.8% (3). Additionally, dedicated phlebotomy teams with proper training in aseptic technique have been shown to further reduce CRs from 4.8% to 1.2% (3). The most likely source for BC contamination is the patient's skin at the venipuncture site, signifying that adequate skin antisepsis is critical in reducing CRs.Chlorhexidine (CH) and iodine tincture (IT) have been shown to be more effective than povidone iodine (PI) for reduction of contamination (4, 5, 6); however, no statistically significant difference has thus far been found to exist between CH and IT (6, 7). A recent prospective randomized crossover trial reported by Washer et al. (6) directly compared CRs between CH, IT, and PI as antisepsis methods. They found no statistically significant difference between them; however, the overall CR for the study period was only 0.76%, which is considerably lower than the average CR at most medical centers across the United States (6). This low baseline CR may make significant differences between antisepsis methods difficult to distinguish.Bo...

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“…This study corroborates and supports the recent findings of Washer et al (6). Similar to those investigators, we found virtually no difference in CRs between CH and IT.…”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Story-Roller

Weinstein

2016

J Clin Microbiol

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“…7,8 Contaminants have been reported to result in false positive blood cultures in anywhere between 2.4% and 50% of cases. [7][8][9][10][11] These false positive results have been associated with prolonged hospitalisation and a 20% increase in healthcare cost. 12 Blood cultures have been shown to have little effect on clinical management in women with pyelonephritis and acutely unwell surgical patients.…”

mentioning

confidence: 99%

Blood cultures in acute surgical admissions

Dunne

McDonald

Ratnayake

et al. 2015

annals

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INTRODUCTION Obtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions. METHODS Data on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management. RESULTS Of 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%). CONCLUSIONS Blood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.

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Technical Improvements in Culturing Blood

Pardini¹

2014

Methods in Molecular Biology

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Blood culture is a laboratory test where a blood specimen, taken from a patient, is inoculated into bottles containing culture media to determine if infection-causing microorganisms (bacteria or fungi) have invaded the patient's bloodstream. This test is an important investigation with major implications for the diagnosis and treatment of patients with bloodstream infections and possible sepsis. Moreover, blood culture will also provide the etiologic agent for antimicrobial susceptibility testing, enabling optimization of antibiotic therapy with significant impact on the outcome of the disease. Even if the potential benefices of blood culture are well known, critical factors mainly in pre- and post-analytical phases can reduce the clinical value of this test.

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Blood Culture Contamination A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

Abstract: ClinicalTrials.gov identifier: NCT01216761 .

Cited by 46 publications

References 23 publications

Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Blood cultures in acute surgical admissions

Technical Improvements in Culturing Blood

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