Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line–associated bloodstream infections

Garcia, Robert; Spitzer, Eric D.; Beaudry, Josephine; Beck, Cindy; Diblasi, Regina; Gilleeny-Blabac, Michelle; Haugaard, Carol; Heuschneider, Stacy L.; Kranz, Barbara P.; McLean, Karen; Morales, Katherine L.; Owens, Susan; Paciella, Mary E.; Torregrosa, Edwin

doi:10.1016/j.ajic.2015.06.030

Cited by 112 publications

(116 citation statements)

References 127 publications

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“…However, no recommendation can be made as to where additional blood cultures should be drawn. Options include: (a) all cultures drawn peripherally via venipuncture, (b) cultures drawn through each separate intravascular device but not through multiple lumens of the same intravascular catheter, or (c) cultures drawn through multiple lumens in an intravascular device [66][67][68][69][70].…”

Section: Diagnosismentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: Diagnosismentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Algunos estudios muestran que las soluciones de clorhexidina en base alcohólica son mejores que iodo-povidona en solución acuosa y disminuyen el porcentaje de contaminación al 2% frente a la iodo-povidona (>3,0%), con la ventaja del efecto residual de la biguanida frente al yodóforo. Para la selección del antiséptico a utilizar se debe tener en cuenta el tiempo de acción, capacidad de reducción de la flora de la piel y los efectos adversos asociados a su uso 8,15,16 .…”

Section: Discussionunclassified

“…En un estudio aleatorizado, se encontró que el porcentaje de contaminación fue 0,6 % cuando la muestra se obtuvo con guante esté-ril y 1,1% cuando se utilizó guante limpio no estéril 8 .…”

Section: Discussionunclassified

“…El estudio Q-probes del Colegio Americano de Patólogos (CAP), realizado en 640 hospitales, determinó que la aplicación de un antiséptico en la tapa de la botellas se asoció con una tasa de contaminación de 2,3%, comparada con un 3,4% en los que no realizan esta desinfección, sin embargo, los productos yodados no deben utilizarse ya que puede erosionar el material del tapón, facilitando la introducción de potenciales contaminantes 8 .…”

Section: Discussionunclassified

“…En este sentido, el laboratorio clínico juega un papel crucial en los procesos relacionados con los hemocultivos incluyendo las variables pre-analíticas, analíticas y post-analíticas, por lo que han sido publicadas recomendaciones con énfasis en el tiempo de incubación, el número y tipo de botellas, el volumen de sangre, el reporte de contaminantes y las limitaciones de los sistemas actuales de hemocultivos 7 . De acuerdo con una revisión reciente sobre las prácticas relacionadas con la realización de los hemocultivos, la optimización debe estar dirigida a mejorar tres desenlaces: incrementar el aislamiento e identificación de los verdaderos patógenos, disminuir la presencia de contaminantes y mejorar la detección de infecciones asociadas a catéteres centrales 8 . Se ha demostrado, por ejemplo, que los procesos eficientes de antisepsia permiten disminuir el impacto del aislamiento de potenciales contaminantes en hemocultivos, lo cual genera incertidumbre diagnóstica, prolongación de la estancia hospitalaria e incremento de los costos de la atención en salud 9 .…”

Section: Introductionunclassified

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Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá.

Maldonado

Nagles

Robledo

et al. 2017

Infect

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Cómo citar este artículo: N. Maldonado, et al. Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá. Infectio 2018; 22(1): 19-25 Resumen Objetivo: Caracterizar procedimientos para la toma, análisis, reporte y aseguramiento de la calidad en hemocultivos en pacientes adultos, en instituciones hospitalarias. Material y método: Estudio descriptivo en 15 hospitales de Medellín y alrededores. Se empleó un formulario semiestructurado para recolectar la información, se utilizó SPSS ® para el análisis. Resultados: Todas las instituciones tienen protocolos basados en fuentes de autoridad reconocida; con diferencias importantes en procesos pre-analíticos y postanalíticos. Los productos más empleados para la antisepsia fueron gluconato de clorhexidina al 2-4% (66,7%) y alcohol isopropílico o etílico al 70% (20,0%), con discrepancias en los tiempos de acción. El 73,3% emplea guantes estériles y la misma proporción usa sistema abierto (jeringa) para la venopunción. En el 46,6% se toman dos botellas aerobias y una anaerobia por episodio y en 33,3% dos botellas aerobias. El 66,6% lleva un indicador de contaminación, 53,3% de positividad y 26,6% de volumen de sangre. La tasa promedio de hemocultivos contaminados durante el semestre de seguimiento fue 1,61%. Conclusión: Se observa heterogeneidad en los procedimientos, especialmente en fases pre-analítica y post-analítica. En la búsqueda de la excelencia y la seguridad del paciente son necesarios protocolos estandarizados e indicadores para medir y controlar el desempeño de los hemocultivos. AbstractObjective: To characterize the procedures that are performed for the collection, analysis, reporting and quality assurance of blood cultures in adult patients in hospital institutions. Material and Methods: Descriptive study in 15 hospitals of Medellin and its surroundings. A semi-structured collection instrument was used to collect the information provided by each hospital; SPSS® was used for the analysis. Results: All institutions have protocols based on authorized sources; there were important differences in the pre-analytic and post-analytic processes. The products employed for skin antisepsis were 2-4% chlorhexidine gluconate (66.7%) and 70% isopropyl or ethyl alcohol (20.0%), with discrepancies in product action times. 73.3% use sterile gloves and an equal proportion uses an open system (syringe) for venipuncture. Two aerobic and one anaerobic bottles are taken per episode in adult patients in 46.6% of institutions and only two aerobic bottles in 33.3% of them. Indicators of contamination were used by 66.6 % of institutions, of positivity in 53.3% and of blood volume in 26.6%. The average rate of contaminated blood cultures during the follow-up period was 1.61%. Conclusion: Heterogeneity in the procedures was observed especially in the pre-analytic and post-analytical phases. In the pursuit of excellence and patient safety, standardized protocols and the use o...

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Significance of blood culture testing after pancreatoduodenectomy

Aritake,

Natsume,

Asano

et al. 2024

Annals of Gastroent Surgery

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AimThe aim of this study was to clarify the significance of blood culture testing in the postoperative period of pancreatoduodectomy (PD), a highly invasive surgery.MethodsRates of blood culture sampling and positivity were investigated for febrile episodes (FEs) in patients who underwent PD (2016–2021). FEs were defined as body temperature of 38.0°C or higher occurring on or after the 4th postoperative day. Fever origin was diagnosed retrospectively, and FEs were classified as pancreatic fistula (PF)‐related or PF‐unrelated FEs. Factors correlated with blood culture positivity were explored.ResultsAmong 339 patients who underwent PD, 99 experienced 202 FEs. Blood culture testing was performed on 160 FEs occurring in 89 patients. The sampling and positivity rates were 79.2% and 17.5%, respectively, per episode and 89.9% and 28.1%, respectively, per patient. Thirty‐six FEs were classified as PF‐related and 124 were classified as PF‐unrelated FEs. The blood culture positivity rate was significantly lower in PF‐related vs. PF‐unrelated FEs (1/36 vs. 27/124, respectively, p = 0.006). The blood culture positivity rate was significantly higher in patients with cholangitis, catheter‐related blood stream infection, and urinary tract infection than PF‐related FEs. Multivariate analysis showed that blood culture positivity was negatively associated with PF‐related FEs and positively associated with accompanying symptoms of shivering, Pitt Bacteremia Score, and preoperative biliary drainage.ConclusionsPatients who underwent PD showed relatively high blood culture positivity rates. Based on these results, it may be possible to distinguish PF‐related and ‐unrelated FEs.

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Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line–associated bloodstream infections

Cited by 112 publications

References 127 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Caracterización de los procedimientos para la realización de hemocultivos en pacientes adultos, en instituciones hospitalarias del Área Metropolitana del Valle de Aburrá.

Significance of blood culture testing after pancreatoduodenectomy

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