Comparison of Four Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Randomized Trial

Calfee, David P.; Farr, Barry M.

doi:10.1128/jcm.40.5.1660-1665.2002

Cited by 94 publications

(73 citation statements)

References 19 publications

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“…The overall blood culture contamination rate in this study, 4%, lies within the wide range (0.42% to 15.1%) reported previously for various settings (1,2,4,10,11,15,19,24,31,32,34,38) and is close to that of other ICU populations (5.5% [7]). The overall blood culture rate of detection of true pathogens is similarly consistent with those reported previously for other ICU patient series, 4.6% (7) to 12.8% (21).…”

Section: Discussionsupporting

confidence: 48%

Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture

et al. 2011

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Severe sepsis, defined as acute organ dysfunction secondary to infection, is the most common cause of death in noncardiac intensive care units (ICUs) (22). Blood cultures serve as a reliable, if imperfect, test for detecting the bacteremia often associated with sepsis and as a vital tool in tailoring antibiotic therapy (8, 36). However, blood culture contamination (with organisms that do not reflect true bacteremia) frequently complicates the interpretation of blood culture results (30), leading to unnecessary antibiotic administration (20) and adding significantly to the length of hospital stay and the cost of care (1).Central lines are often inserted into unstable ICU patients when sepsis is suspected, in order to measure central venous pressure, direct fluid resuscitation, obtain venous oxygen saturation (33), and facilitate the safe administration of vasoactive drugs. The strict aseptic techniques and sterile-barrier precautions employed during central line insertion (in order to reduce the incidence of central line-associated bloodstream infections [28]) far exceed those taken when obtaining blood cultures from peripheral venipuncture. Since suspected sepsis is also an indication for obtaining blood cultures, and since central lines are inserted under strict sterile precautions, obtaining blood cultures during central line insertion presents an attractive opportunity to minimize the risk of culture contamination. Indeed, this is a common ICU practice.The principal hypothesis examined in this study was that the rate of contamination of blood cultures taken at central line insertion would be lower than that of blood cultures taken from peripheral venipuncture. This question is important in order to establish the validity of central line insertion blood cultures.(This work was presented in part as a poster at the International Symposium of Intensive Care and Emergency Medicine, Brussels, Belgium, 2011.) MATERIALS AND METHODSSetting and data collection. The Hadassah-Hebrew University Medical Centre is a 775-bed academic tertiary care hospital. Data on all blood cultures taken from patients in the 12-bed adult general (mainly surgical) ICU (GICU) and the 9-bed medical ICU (MICU) between January 2005 and June 2010 were obtained retrospectively from the computerized microbiological laboratory database. Cultures taken from existing lines (not at the time of insertion) were excluded. A waiver of informed consent was granted by the institutional research ethics committee, as this was considered a quality control initiative, and there were no patients identified or treatments given.The following information was extracted for each blood culture: ICU of patient admission, date of specimen collection, culture result, and source of blood culture (peripheral venipuncture, central venipuncture during central venous catheter insertion, or arterial puncture during arterial catheter insertion). Central venous catheters included single-, double-, and triple-lumen catheters; temporary dialysis catheters; and pulmonary-artery cat...

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Section: Discussionsupporting

confidence: 48%

Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture

et al. 2011

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“…However, it remains unclear which antiseptic should be used to effectively minimize contamination. Some studies had conflicting results, and others were not ideally designed to answer the research question (4,9,15,16).Traditionally, the combination of an alcohol and an iodinecontaining disinfectant has been employed at many hospitals, but there is no firm evidence that this combination provides an additive effect in reducing contamination rates. The application of povidone-iodine (PI) requires extra time, thereby making the procedure more complicated.…”

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Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

et al. 2009

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Despite a number of studies on the efficacies of antiseptics for the prevention of blood culture contamination, it still remains unclear which antiseptic should be used. Although the combination of povidone-iodine and isopropyl alcohol has been traditionally used in many institutions, the application of povidone-iodine needs extra time, and there is little evidence that this combination could have an additive effect in reducing contamination rates. To elucidate the additive efficacy of povidone-iodine, we compared two antiseptics, 70% isopropyl alcohol only and 70% isopropyl alcohol plus povidone-iodine, in a prospective, nonrandomized, and partially blinded study in a community hospital in Japan between 1 October 2007 and 21 March 2008. All blood samples for culture were drawn by first-year residents who received formal training on collection techniques. Skin antisepsis was performed with 70% isopropyl alcohol plus povidone-iodine on all inpatient wards and with only 70% isopropyl alcohol in the emergency department. For the group of specimens from inpatient wards cultured, 13 (0.46%) of 2,797 cultures were considered contaminated. For the group of specimens from the emergency department cultured, 12 (0.42%) of 2,856 cultures were considered contaminated. There was no significant difference in the contamination rates between the two groups (relative risk, 0.90; 95% confidence interval, 0.41 to 1.98; P ‫؍‬ 0.80). In conclusion, the use of a single application of 70% isopropyl alcohol is a sufficient and a more cost-and time-effective method of obtaining blood samples for culture than the use of a combination of isopropyl alcohol and povidone-iodine. The extremely low contamination rates in both groups suggest that the type of antiseptic used may not be as important as the use of proper technique.The collection of blood samples for culture is essential for the diagnosis and management of patients with suspected bacteremia, and the importance of this practice has recently been reconfirmed in the Clinical and Laboratory Standards Institute's guideline Principles and Procedure for Blood Cultures in 2007 (5). However, the problem of false-positive results due to contamination has remained since the beginning of the use of modern techniques over 70 years ago. Contamination most commonly occurs when exogenous bacteria are inoculated into the culture medium from the patient's skin, the phlebotomist's hands, or phlebotomy kits. Contamination rates below 3% are generally considered acceptable (5, 9). Nevertheless, the reported rates of contamination vary from 0.8% to over 8% among institutions. Almost half of all positive results were reported to be contaminants at some institutions (1,4,15,18,20,23,24,26,31). With such a high contamination rate, it is not easy to interpret the results properly for clinicians. Consequently, contaminated blood cultures lead to extra costs because of the unnecessary use of antibiotics, prolonged hospitalization, and the subsequent possible development of antimicrobial resistance (3,15,23,25...

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“…Multiple prospective trials have found that chlorhexidine or tincture of iodine are much more ef-fective than povidone iodine for cutaneous antisepsis before drawing the blood sample, providing 50% lower rates of contamination, on average. 51 " 55 Having a team of trained phlebotomists to collect all blood for culture, 56 providing feedback to phlebotomists regarding contamination rates, 57 and tracking of the blood-culture contamination rate 58 as a quality indicator are all practices that have been shown to lower contamination rates.…”

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Safdar

Maki

2006

Infect. Control Hosp. Epidemiol.

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Comparison of Four Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Randomized Trial

Cited by 94 publications

References 19 publications

Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture

Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

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