G484(P) Blood culture processing time for neonates on the postnatal ward and length of hospital stay

Abstract

AimsApproximately 10% of neonates on postnatal wards deemed to be at risk of sepsis are screened and treated with intravenous (iv) antibiotics until blood culture (BC) results are available (NICE guideline). C-reactive protein (CRP) and clinical wellbeing are assessed, but a negative BC result after 36 or 48 hours is the gold standard with regard to stopping antibiotics and discharging babies home. Our aim was to review the time taken to process BCs and hence report BC results and the impact on length of stay.MethodsData were collected on all babies who were screened for risk factors for sepsis and received iv antibiotics on the postnatal ward of a maternity unit with 5500 deliveries per annum, between September 2013 and August 2014. The time between BC collection and the BC being processed, i.e., the time from the BC being sent from the neonatal unit and incubation beginning in the laboratory, and the result being reported were recorded for all babies.ResultsSix-hundred and ninety-three babies were screened and treated for risk factors during the study period, two infants admitted to NICU were excluded. In total, the 691 infants received 3430 doses of iv cefotaxime and occupied 1870 bed days. There was only one positive BC and this was due to Group B Streptococcus. The time between collection of the BC and onset of processing ranged between 1 and 72 hours. In 83 babies, who had negative blood cultures and a CRP <20 on two occasions, the mean length of stay was 5.1 days (total 426 days). If the BCs had been processed immediately and the BCs reported in 36 or 48 hours, this would have resulted in a reduction of 301 or 260 postnatal days’ admission respectively. The resultant costs of care saving would have been £1 09 958 and £94 980 respectively.ConclusionTimely processing of blood cultures would facilitate earlier discharge. Decreasing length of stay would result in significant cost savings and increases bed availability on busy maternity units.