Initial Specimen Diversion Device® reduces blood culture contamination and vancomycin use in academic medical centre

Nielsen, Lindsey; Nguyen, Ken; Wahl, Clinton K.; Huss, Jodi L.; Chang, David C.; Ager, Edward; Hamilton, Lynette

doi:10.1016/j.jhin.2021.10.017

Cited by 9 publications

(23 citation statements)

References 44 publications

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“…BCC events to a greater extent than has been previously observed. [20][21][22][23] Moreover, ours is the first study to address the impact of contamination on false-positive CLABSIs. Notably, phlebotomists performing traditional venipuncture without the ISDD likely had higher BCC rates than RNs because phlebotomists drew most blood samples from inpatients, including those in the intensive care units and those considered to be 'hard stick' patients, whereas RNs drew blood samples primarily from ED patients who overall are not as difficult to draw from.…”

Section: Discussionmentioning

confidence: 96%

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Tompkins

Tien

Madison

2022

Infect. Control Hosp. Epidemiol.

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Objective: To assess the impact of initial specimen diversion device (ISDD) on inpatient and emergency department blood culture contamination (BCC), central-line–associated bloodstream infection (CLABSI) standardized infection ratios (SIRs), and antibiotic administration. Design: Single-center quasi-experimental prospective cohort study wherein phlebotomists used traditional venipuncture with or without the ISDD while registered nurses (RNs) used traditional venipuncture. Method: BCC events among phlebotomists and RNs were observed and compared from March 17, 2019, through January 21, 2020, defined by contaminant detection in 1 of 4 bottles for matched sets or 1 of 2 bottles in both subsets for coagulase negative staphylococci. CLABSIs throughout this period were recorded and SIRs were calculated. Enhanced oversight took place through July 21, 2019, with chart review assessing antibiotic use for patients with possible BCC. Results: Overall, 24% of blood cultures obtained were from patients in intensive care. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate; phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs drew 7,411 BCs with a 0.8% BCC rate. The CLABSI SIR was decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019. The CLABSI incidence was 33%–64% of predicted value for each 2019 quarter. This range fell to 18%–37% after the exclusion of likely false-positive results. Among 42 patients with possible BCC under enhanced oversight, 2 patients were treated with prolonged antibiotic courses. Conclusions: ISDD use by phlebotomists was associated with BCC reduction and reduced false-positive CLABSI results. This patient-care quality improvement could constitute sustainable antibiotic stewardship expansion.

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Section: Discussionmentioning

confidence: 96%

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Tompkins

Tien

Madison

2022

Infect. Control Hosp. Epidemiol.

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“…A contaminated case of blood culture is associated with unnecessary treatment [ 25 ]. ASPs should target to reduce the DASC of contaminated cases including BSIs due to fungi, although this study could not discriminate against other existing infections [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study

et al. 2022

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The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.

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“…Furthermore, the most challenging interpretation is determining if the organism recovered from the blood culture is an actual pathogen that causes bloodstream infection or a contaminant (false positive). If it is a contaminant, the patient can end up getting antibiotics when they are not necessary, which would put the patient at more risk (Nielsen et al, 2022). Since there is no specific treatment for sepsis, it is difficult to understand the primary etiology.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of complete blood count, c-reactive protein, and lactate dehydrogenase in culturable and unculturable bacteremia for early diagnosis of sepsis

Kadim

AL-Dahmoshi²

2022

JANS

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Bacteremia is a bacterial infection that enters the bloodstream. This study was designed to investigate if culture methods could detect the bacterial infection of the bloodstream and to assess certain criteria for bacterial sepsis in culturable and non-culturable blood samples from hospitalized patients, like C-reactive protein (CRP), lactate dehydrogenase (LDH), and complete blood count (CBC). A total of 100 blood samples from patients with symptoms of sepsis who resided in the Hilla City hospital were collected as well as 25 samples as a healthy control group without disease or inflammation. Each sample was divided into three containers; 2ml in an EDTA tube for the CBC test, 3ml in a centrifuged tube for the CRP and LDH test, and 3-7ml in brain heart infusion broth for blood culture. The study result showed that 65 (65%) of 100 samples had abnormal tests, whereas only 25 (25%) of 100 were culture positive. There was a statistically significant difference between patients and control regarding all parameters CRP, LDH, white blood cell (WBC), lymphocyte (LYM) and granulocyte (GRA) (P= 0.000). No significant association in studied parameters was observed between culture-positive and culture-negative patients. Significant strong positive correlation was observed between WBC and LDH (r= 0.332) (p= 0.007), LYM and GR) (r= -0.983) (p= 0.000), LYM and CRP (r= 0.257) (p= 0.03), and between GRA and LDH (r= 0.254) (p= 0.04). Therefore, the estimation of WBC, granulocytes, lymphocytes count, CRP and LDH values and blood culture results may help in the early identification of the causative agent of sepsis.

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Initial Specimen Diversion Device® reduces blood culture contamination and vancomycin use in academic medical centre

Cited by 9 publications

References 44 publications

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study

Evaluation of complete blood count, c-reactive protein, and lactate dehydrogenase in culturable and unculturable bacteremia for early diagnosis of sepsis

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