Simple measures to reduce the rate of contamination of blood cultures in Accident and Emergency

Abstract

Objectives: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. Methods: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe.Results: There was a statistically significant reduction in the number of contaminants (p = 0.03). Conclusions: Simple measures to encourage skin disinfection and appropriate sampling technique will reduce the incidence of contamination of blood cultures in the A&E department.T he usefulness of blood cultures taken in the Accident and Emergency department (A&E) remains open to question. In two A&E based studies only 1.6% of blood cultures taken in one study had an impact on the management of patients 1 and in another only 0.52% potentially had their medical management affected by the positive blood culture results. 2Contamination of blood cultures is also a common problem and false positive results due to contaminants may lead to errors both in clinical interpretation and administration of inappropriate treatment. There are several problems in A&E which may contribute to high contamination rates of blood cultures-these include a rapid turnover of staff, lack of ongoing training, workload, and the nature of the presenting patients. Our study shows the effect that the provision of information on skin decontamination has on the contamination rate in A&E. METHODSThe infection control team, in partnership with the A&E consultant staff, introduced a blood culture sampling kit. This contained BacT/ALERT (Biomerieux, Basingstoke, Hants, UK) sampling bottles but the bottles were placed in a polythene sleeve with enclosed pocket size instructions on how to take blood cultures (fig 1) and a large 62% ethyl alcohol impregnated wipe (Purell, Gojo Industries, Arkon, OH, USA) for cleaning the patient's skin before venepuncture.The medical and nursing staff in A&E were instructed on how to use the blood culture kits but no additional formal training was given on venepuncture. The interventions were timed to occur in the middle of the junior doctors' rotation period to minimise the effect that staff changes may have had on the study.The request form was marked in order to allow the laboratory to identify which blood culture samples had been collected using the kit method. Bacteria were identified using standard microbiological techniques. A blood culture contaminant was defined as a usual skin organism that was isolated from only one set of blood cultures in a patient with no evidence of an infection with that organism. RESULTSIn the month before the intervention 50 sets of blood cultures were taken, 35 (70%) had no bacterial growth, three (6%) were judged to have significant growth, and 12 (24%) were judged to contain contaminants. In the month following the intervention 50 sets of blood cultures were also taken; 37 (74%) had no bacterial growth, nine (18%) were judged to have significant growth, and four (8%) were judged to con...

Blood Cultures and Central Catheters: Is the "Easiest Way" Best Practice?

“…10 Antiseptics with more rapid drying time are preferred over povidone-iodine to allow samples to be obtained more quickly. 10 In 1 study, 14 use of blood culture sampling kits significantly reduced contamination rates from 24% to 8%. The kit included sample bottles, an instruction sheet, and a large wipe impregnated with 62% ethyl alcohol for cleansing the skin before venipuncture.…”

“…The kit included sample bottles, an instruction sheet, and a large wipe impregnated with 62% ethyl alcohol for cleansing the skin before venipuncture. 14 …”

The effect of a quality improvement programme reducing blood culture contamination on the detection of bloodstream infection in an emergency department

“…Several studies have shown that reducing BC contamination is possible through simple, inexpensive interventions -typically a combination of education, feedback and use of BC packs (Madeo et al, 2005;Murillo et al, 2011;Marini and Truog, 2012;Youssef et al, 2012;Self et al, 2013;Harding and Bollinger, 2013). These studies have principally focused on reducing rates of contaminated cultures in order to reduce the costs associated with false positive cultures.…”

“…However, clinically irrelevant bacteria from the patient's skin, often termed BC contaminants, can also be cultured if a proper sampling technique is not observed. A contamination rate of <3% is considered acceptable, (Schifman et al, 1998; Department of Health, 2007) but contamination rates often exceed this, particularly in emergency departments (ED) (Madeo et al, 2005;Gander et al, 2009;Murillo et al, 2011;Self et al, 2013;Harding and Bollinger, 2013). Concern has been raised over the clinical and financial cost of BC contamination.…”

Reducing blood culture contamination rate: A quality assurance project in a Malaysian tertiary hospital

“…the inclusion of simple measures such as enclosing advisory leaflets, posters and providing reminder chit on blood culture bottles could be effective strategies. 8 throughout the study, the main challenge was keeping in tract of new housemen to be included in the program as fast turnaround time of housemen rotation in medical department as well as flexi-hours working hours were the greatest challenge. Somehow we achieved 95% coverage of housemen from medical department for the campaign.…”