Nurses’ competency in drawing blood cultures and educational intervention to reduce the contamination rate

Abstract

Compared with truly negative cultures, false positive blood cultures (BCs) not only increase laboratory work but also prolong the lengths of patient stays, which are likely to increase patient morbidity and costs. The present study aimed to evaluate the effectiveness of a hospital-wide educational intervention on BC contamination rates. Nurses performed all phlebotomies; therefore, educational workshops were offered to all nurses twice a week over a 3-month period. The workshops consisted of a questionnaire, PowerPoint presentation, video show, demonstration of the different materials used to collect BCs, and question session. Data from the questionnaires and laboratory culture results were compared between the 6-month pre- and post-intervention periods. Of the 503 eligible nurses, 216 (42.9%) attended the workshops. The survey identified areas for improvement, which included time of disinfectant application, volume of blood to be cultured, and disinfection of BC bottle tops. Of the 9903 BC sets that were drawn from 3649 patients during the study period, 676 (6.8%) were contaminated. The monthly BC contamination rates for the 6-month pre- and post-intervention periods were 8.1% and 5.2%, respectively, representing a 36% reduction (P=0.008). Only three wards had an acceptable contamination rate of ≤3% before the intervention, compared with eight wards after the intervention. While contamination of BCs can never be completely eliminated, there is evidence that adherence to best practice BC collection techniques can minimize BC contamination, which might be best achieved with a dedicated phlebotomy team.

Blood culture contamination in a tertiary care hospital of Saudi Arabia

“…Trained and competent nurses have been reported to result in fewer contaminated blood cultures. 9 Recent studies suggest that the technique employed to disinfect the venipuncture site followed by a few minutes of drying time impacts the BCC rate rather than the antiseptic. 2,17 However, the effectiveness of alcoholic solution prior to BC sampling has also been reported in reducing contamination rate.…”

“…Despite a multitude of information on the adverse impact of improperly collected blood cultures, to our knowledge, there is paucity of studies on BCC in Saudi Arabia. 8,9 Herein, we explored the rate of contamination in cultures of blood submitted to the Microbiology Laboratory of King Fahad Hospital, a tertiary care Hospital in Madina, Saudi Arabia.…”

Successful Reduction of Blood Culture Contamination in an Emergency Department by Monitoring and Feedback

“…While adherence to evidence-based best practice when collecting BCs is supposed to be the standard of care, compliance can be unsatisfactory and the high BC contamination rate might be a result of the lack of training and education, lack of surveillance and monitoring, inadequate staffing, shortage of materials, or the use of poor quality materials [7]. From previously published work, hospital-wide educational intervention had led to reductions in contamination rates at our institution, but rates for the ED remained high due to lack of attendance [13]. Because our hospital did not invest in the establishment of a dedicated phlebotomy team for BC collection, the present study investigated the effect of detailed monitoring and monthly feedback on contamination rate.…”

“…Contaminated BCs increase laboratory costs by approxi-mately 20%, are associated with a nearly 40% increase in antibiotic charges, and as much as 5 additional days in the hospital [1, 8 -10]. Several techniques have been used to reduce BC contamination including the use of specific disinfection materials [2,11], educational interventions [2,6,12,13], collection from separate venipuncture sites [5,7], use of the outmoded double-needle technique [7], commercial BC kits [3,14,15], and reliance on specially trained staff or dedicated phlebotomy teams [2,7,8,16]. The aims of the present study were to assess BC contamination in the ED and the impact of monthly monitoring of BC contamination and feedback on contamination rate.…”

A novel approach to eliminate detection of contaminating Staphylococcal species introduced during clinical testing

“…Due to the widespread presence of CONS, it is challenging to obtain a clinical sample or to produce testing reagents without any low level contamination. For example, in clinical blood cultures used to identify pathogens causing blood stream infections, 20–30% of all positive cultures are due to contamination, presumably from poor skin or needle cleaning during the veni-puncture [ 8 , 9 , 10 , 11 , 12 ]. Of these contaminants, 80% are caused by CONS species [ 13 , 14 ].…”