Establishing a Long-Term Model for Analysis and Improvement of Underfilled Blood Culture Volumes

Zaleski, Michael; Erdman, Patrick; Adams, JG; Michael, Amanda; Rudy, Abigail; Boesch, Robert; Allison, L.; Mailander, Patricia; Hess, Wendell; Myers, Debra S.; Craft, David W.

doi:10.1093/ajcp/aqy125

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…[16][17][18] Automated BC volume measurements have enabled largerscale feedback and education interventions across several healthcare systems showing reduced BC underfilling, in some cases associated with increased BC true positivity rate. [19][20][21] The incidence of solitary BC sets in the ED has been shown to range from 16.9% to >90% 9,22 and from a wider hospital perspective 48% to 94%. 23,24 Despite this, published interventions to reduce solitary BC are few.…”

Section: Discussionmentioning

confidence: 99%

Changing culture: An intervention to improve blood culture quality in the emergency department

Williams,

Hills,

Ray

et al. 2023

Emerg Medicine Australasia

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ObjectiveBlood cultures (BCs) remain a key investigation in ED patients at risk of bacteraemia. The aim of this study was to assess the effect of a multi‐modal, nursing‐led intervention to improve the quality of BCs in the ED, in terms of single culture, underfilling and contamination rates.MethodThe present study was conducted in the ED of a large urban tertiary referral hospital. The study included four phases: pre‐intervention, intervention, post‐intervention and sustainability periods. A multi‐modal intervention to improve BC quality consisting small group education, posters, brief educational videos, social media presence, quality feedback, small group/individual mentoring and availability of BC collection kits was designed and delivered by two senior ED nurses over 7 weeks. Study data comprised rates of single, underfilled and contaminated cultures in each of three 18‐week periods: pre‐intervention (baseline), post‐intervention and sustainability.ResultsOver the study period 4908 BC sets were collected during 2347 episodes of care in the ED. Single culture sets reduced from 56.2% in the pre‐intervention period to 22.8% post‐intervention (P < 0.01) and 18.8% in the sustainability period (P < 0.01). Underfilled bottle rates were also significantly reduced (aerobic 52.8% pre‐intervention to 19.2% post‐intervention, 18.8% sustainability, anaerobic 46.8% pre‐intervention to 23.3% post‐intervention, 23.8% sustainability). Skin contaminants were grown from 3.7% of BC sets in the pre‐intervention period, improving to 1.5% in the post‐intervention period (P < 0.001) and 2.1% in the sustainability period (P = 0.03). Total volume of blood cultured was significantly associated with diagnosis of bacteraemia.ConclusionSignificant improvements in BC quality are possible with nursing‐based interventions in the ED.

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Section: Discussionmentioning

confidence: 99%

Changing culture: An intervention to improve blood culture quality in the emergency department

Williams,

Hills,

Ray

et al. 2023

Emerg Medicine Australasia

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“…Such monitoring easily highlights what preanalytical factor needs to be improved, and training (e.g. of nurse or phlebotomists) has thus become pivotal to improve, for example, bottle filling and the quality of skin preparation [14,15]. However, adequate filling may be moderate also in post-intervention assessments [15] and training effects may also fade with time, which calls for new strategies to reach effective training.…”

Section: Op Mize Treatmentmentioning

confidence: 99%

“…of nurse or phlebotomists) has thus become pivotal to improve, for example, bottle filling and the quality of skin preparation [14,15]. However, adequate filling may be moderate also in post-intervention assessments [15] and training effects may also fade with time, which calls for new strategies to reach effective training. Second, manufacturers have implemented technical features for automated estimation of the bottle filling in CMBCSs either with a direct or an indirect estimation of the amount of blood cultured (Table 2) [17,18].…”

Section: Op Mize Treatmentmentioning

confidence: 99%

“…Second, manufacturers have implemented technical features for automated estimation of the bottle filling in CMBCSs either with a direct or an indirect estimation of the amount of blood cultured (Table 2) [17,18]. Data are easily acquired and can be used as an educational tool for quality improvement on the departmental level as summarized in Table 2 [14,15]. Third, initiatives to promote external quality assessment (EQA) of the BC pre-analytical quality in European hospitals have been instituted (www.ctcb.com).…”

Section: Op Mize Treatmentmentioning

confidence: 99%

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Bloodstream infections – Standard and progress in pathogen diagnostics

Lamy

Sundqvist

Idelevich

et al. 2020

Clinical Microbiology and Infection

127

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Background: Bloodstream infection (BSI) is a major public health burden worldwide, with high mortality. Patient outcome is critically influenced by delayed therapy, and fast and accurate pathogen diagnostics decisively improves the care of patients. During the past two decades major improvements have been made in the diagnostic performance of blood culture diagnostics through actions on pre-analysis and time to result. Aims: To review and discuss the literature for standard procedures and the progress in BSI pathogen diagnostics, and to propose a new mindset to reach an improved diagnostic workflow. Sources: Scientific articles and reviews available through NCBI/Pubmed. Content: Blood culture performance relies largely on the quality of its pre-analytical phase that is improved with educational actions monitored by using key performance indicators, and external quality assessment. Advanced blood culture systems now provide tools for an automated estimation of bottle filling. These proved efficient to facilitate effective training for improving blood collection. On analytic aspects, rapid methods for pathogen identification, among which matrix-assisted laser desorption/ ionization time of flight mass spectrometry dominates, and rapid antimicrobial susceptibility testing are reviewed. These technical developments call for improvements in all other steps, especially in pre-and post-analytic logistics to give the full reciprocation of these techniques on patient management. This aspect is summarized by the term 'microbiologistics', which covers all possible improvements in the logistic chain from sampling to report. Implications: Progress in BSI pathogen diagnostics is based on a bundle approach that includes optimization of the pre-analytical parameters, rapid start of incubation, the use of rapid methods, reorganization (e.g. 24/7, transportation service) and a close involvement of antimicrobial stewardship teams. These developments lead to define a new standard for bloodstream infection diagnostics.

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“…One group found that targeted education in intensive care units (ICUs) led to 30% to 60% sustained improvement in blood volume submitted on average. 22 Another recent study found that a rigorous quality improvement program that included group education, targeted communications, and bottle marking led to not only considerably increased blood volume (increased from 2.3 mL average per bottle before implementation to 8.6 mL after implementation) but most importantly a 20% improved yield of true pathogens in blood culture. 23 …”

Section: Volume Of Blood Collected For Culturementioning

confidence: 99%

Modern Blood Culture

Gonzalez

Chao

Pettengill

2020

Clinics in Laboratory Medicine

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The optimal care of septic patients depends on the successful recovery of clinically relevant microorganisms from blood cultures and the timely reporting of organism identification and antimicrobial susceptibility testing (AST) results. Many preanalytic factors play a critical role in culturing microorganisms, and advancements in blood culture instrument technology have reduced the time to positive results. Additionally, rapid organism identification and AST results directly from positive blood culture broth via new methods help to further shorten the time from empiric to targeted treatment. This article summarizes the current state of blood culture methods, including preanalytic, analytical, and postanalytic factors that are available to clinical microbiology laboratories.

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Establishing a Long-Term Model for Analysis and Improvement of Underfilled Blood Culture Volumes

Cited by 5 publications

References 13 publications

Changing culture: An intervention to improve blood culture quality in the emergency department

Changing culture: An intervention to improve blood culture quality in the emergency department

Bloodstream infections – Standard and progress in pathogen diagnostics

Modern Blood Culture

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