Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Alahmadi, Yaser M.; McElnay, James; Kearney, Mary P.; Aldeyab, Mamoon A.; Magee, Fidelma A.; Hanley, Joanne; Bailie, Ross; Donaldson, William S.; Johnston, K.Wayne; Kinoulty, S.; Doherty, Alidene; Tate, A.; Scott, Michael

doi:10.1017/s0950268814003008

Cited by 25 publications

(17 citation statements)

References 25 publications

(42 reference statements)

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“…Despite the strict aseptic procedures in VUmc, contamination rate is comparable to that of other similar sized European hospitals, where rates could be as high as 7.4% [26]. Some improvements could be achieved by implementing an educational program for nurses or by deploying a specialized phlebotomy team [7, 27, 28]. These educational programs should also include instructions regarding the amount of blood volume that should be collected, as underfilling of these bottles reduces sensitivity and increases contamination rate [29].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital

et al. 2019

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BackgroundBlood cultures remain the gold standard for detecting bacteremia despite their limitations. The current practice of blood culture collection is still inefficient with low yields. Limited focus has been given to the association between timing of specimen collection at different time points during admission and their yield.MethodsWe carried out a retrospective observational study by analyzing all 3,890 sets of cultures collected from the 1,962 admitted patients over the seven-month period of this study. We compared the blood culture yield between the early group (≤24 hours after admission) and the late group (> 24 hours of admission). We also investigated the effect of prehospital oral antibiotics and pre-analytical time on the first cultures in the emergency department. Epidemiology and efficiency of blood cultures were studied for each medical specialty.ResultsIn total, 3,349(86.1%) blood cultures were negative and 541(13.9%) were positive for one or more microorganisms. After correcting for contamination, the overall yield was 290 (7.5%). The early group (n = 1,490) yielded significantly more true-positive cultures (10.1% versus 5.8%, P<0.001) than the late group (n = 2,400). The emergency department had a significantly higher yield than general wards, 11.2% versus 5.7% (p<0.001). Prehospital oral antibiotic use and pre-analytical time did not affect the yield of first cultures at the emergency department (p = 0.735 and 0.816 respectively). The number of tests needed to obtain one true-positive culture varied between departments, ranging from 7 to 45.ConclusionThis study showed that blood cultures are inefficient in detecting bacteremia. Cultures collected during 24 hours after admission yielded more positive results than those collected later. Significant variations in blood culture epidemiology and efficiency per specialty suggest that guidelines should be reevaluated. Future studies should aim at improving blood culture yield, implementing educational programs to reduce contamination and cost-effective application of modern molecular diagnostic technologies.

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Section: Discussionmentioning

confidence: 99%

Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital

et al. 2019

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“…However, those authors began with percentages that were lower than the ones in our units of study. Most research that carried out educational interventions of this sort reported a 3% to 4% reduction in contamination levels (21)(22)(23) .…”

Section: Discussionmentioning

confidence: 99%

Efectividad de un programa de formación online en una unidad de enfermería: extracción de hemocultivos

Zaragoza-García

Pérez-García

Orellana

et al. 2019

Rev. esc. enferm. USP

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RESUMEN Objetivo: Evaluar la eficacia de una plataforma formativa en línea de procedimientos en una planta de medicina interna para disminuir los hemocultivos contaminados. Método: Estudio cuasi-experimental con grupos paralelos. La muestra la componen enfermeras de medicina interna de un hospital terciario, con las que se lleva a cabo un programa de formación en línea en relación a la técnica extracción de hemocultivos. Se evalúan conocimientos pre y post intervención sobre la técnica. Además, se estudian los resultados de los hemocultivos 6 meses antes y 3 después de la intervención, analizando los contaminados. Resultados: Participan un total de 48 enfermeras. El conocimiento de la técnica antes de la intervención es homogéneo en ambos grupos, mejorando significativamente con la formación en línea (p=0.0001). El análisis de hemocultivos extraídos previos a la formación muestran niveles de contaminación por encima del estándar internacional, disminuyendo en el grupo intervención hasta el 3% después del programa de aprendizaje. Conclusión: La intervención educativa mediante una plataforma digital se muestra válida para la adquisición de conocimientos y su translación a la práctica clínica.

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“…In the paediatric population, Hall et al [11] showed a reduction in contamination rates by using sterile gloves and a sterile field for blood culture collection in the setting of a paediatric emergency department. Other studies have improved contamination rates by using different skin cleansing solutions [11,12], dedicated phlebotomy teams [13], commercially produced blood culture collection packs [14], staff education programs [15], and by improvements in hand hygiene [16]. Despite these measures, CoNS-positive blood cultures remain problematic for the physician and infant.…”

Section: Background and Aimmentioning

confidence: 99%

A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

et al. 2018

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Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

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Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Cited by 25 publications

References 25 publications

Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital

Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital

Efectividad de un programa de formación online en una unidad de enfermería: extracción de hemocultivos

A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

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