Evaluation of the BD BACTEC FX blood volume monitoring system as a continuous quality improvement measure

Abstract

The yield of blood cultures is proportional to the volume of blood cultured. We evaluated an automatic blood volume monitoring system, recently developed by Becton Dickinson within its BACTEC EpiCenter module, that calculates mean volumes of negative aerobic bottles and generates boxplots and histograms. First, we evaluated the filling degree of 339 aerobic glass blood cultures by calculating the weight-based volume for each bottle. A substantial amount of the bottles (48.3%) were inadequately filled. Evaluation of the accuracy of the monitoring system showed a mean bias of -1.4 mL (-15.4%). Additional evaluation, using the amended software on 287 aerobic blood culture bottles, resulted in an acceptable mean deviation of -0.3 mL (-3.3%). The new software version was also tested on 200 of the recently introduced plastic bottles, which will replace the glass bottles in the near future, showing a mean deviation of +2.8 mL (+26.7%). In conclusion, the mean calculated volumes can be used for the training of a single phlebotomist. However, filling problems appear to be masked when using them for phlebotomist groups or on wards. Here, visual interpretation of boxplots and histograms can serve as a useful tool to observe the spread of the filling degrees and to develop a continuous improvement program. Re-adjustment of the software has proven to be necessary for use with plastic bottles. Due to our findings, BD has developed further adjustments to the software for validated use with plastic bottles, which will be released soon.

How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art

“…Besides, the culture of only 2 bottles (1 set) during a 24-h period from adult patients (hereafter referred to as “solitary BC”), is discouraged in all guidelines, as the sensitivity of only 2 bottles is insufficient. In addition, it must be taken into account that, in the real life, a significant proportion of BCs bottles are not adequately filled (Vitrat-Hincky et al, 2011 ; Willems et al, 2012 ; Lin et al, 2013 ; van Ingen et al, 2013 ; Coorevits and Van den Abeele, 2015 ). The “solitary BC” practice, still common, is not acceptable, due to the detrimental outcome when BSI is not detected and appropriately managed, in terms of antimicrobial treatment (a positive BC will impact on the selection of active anti-infective agents for the appropriate treatment duration), but also to trigger the identification, and eradication of the BSI source (Lamy and Seifert, 2012 ; Baron et al, 2013 ; Accoceberry et al, 2015a ).…”

Improvement of blood culture contamination rate, blood volume, and true positive rate after introducing a dedicated phlebotomy team

“…Therefore, automated monitoring of blood volumes has been suggested as a way to increase blood culture yield. The BACTEC™ FX system, an automated blood culture monitoring system, provides reliable estimates of the blood volume in blood culture bottles with a mean error of 0.2 ml, and is considered a useful tool to guide quality improvement policies [13].…”

Clinical Performance Evaluation of VersaTrek 528 Blood Culture System in a Chinese Tertiary Hospital

“…Many laboratories use a set of aerobic and anaerobic bottles per specimen in routine blood culturing (Mirrett et al, 2004; Coorevits and Van den Abeele, 2015). Clinical microbiology laboratory directors and supervisors must frequently face the problem of selecting the optimal BC system for use in their laboratory (Mirrett et al, 2003).…”