Practical Steps to Lower Blood Culture Contamination Rates in the Emergency Department

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

“…An intervention program designed to educate staff, standardize practices to include the use of a 2% CHG with 70% IPA skin antisepsis product, avoid repalpating the site with a nonsterile glove, and provide feedback to ED nursing staff resulted in the reduction in the rate of BCC from 12% to 2% and 1.5% in 2 EDs. 139 Several factors appeared to contribute to this result. Of note, the institution's IP recommended the use of a 1-step CHG-IPA product, which expedites skin antisepsis procedures (ideal in the fast-paced environment of an ED) and rewards staff with zero contaminations with annual certificates of excellence.…”

“…135 Table 3 summarizes studies that have reported successful strategies in reducing contamination rates and other associated outcomes in EDs. 53,71,78,79,[136][137][138][139][140][141][142] A common practice in Pediatric EDs is to obtain a sample for BCs simultaneously when inserting a peripheral intravenous catheter (PIV). Such practice often occurs because of the difficulty in accessing veins in children and avoiding additional sticks.…”

Taxa de contaminação de testes hematológicos e seus fatores determinantes

“…(1)(2)(3)8,16) Regarding the number of needles used, no significant results were obtained. According to the reviewed bibliography, the single-needle with pre-attached holder (Vacutainer®) is considered to increase the inoculation sterility of the tubes and reduce the risk for professionals.…”

“…(14,15) The use of sterile gloves influences the amount of contamination and reduces the number of microorganisms responsible for the creation of false positives by up to 50%. (16,17) Its use should be reduced to the moments prior to preparation of the patient's skin, i.e. the location of the point of puncture and cleaning of the skin.…”

Identification of patients at risk of contaminated blood culture

“…Clinical and Laboratory Standards Institute (CLSI) () ‘place an acceptable blood culture contamination rate at 3%’ (p. 1). Blood culture results are used to guide treatment decisions; thus, when blood culture is contaminated, unnecessary and prolonged hospital stays, additional laboratory costs and overuse of antibiotic therapy may be the result (Denno & Gannon ). Previous research has identified the following to be at increased risk of blood culture contamination: patients who are infectious upon arrival at the ED, patients with a previously unknown or under‐treated infection and patients with limited physical sites to obtain a specimen (Hall & Lyman ).…”