Use of a Sterile Collection Process to Reduce Contaminated Peripheral Blood Cultures

Abstract

BACKGROUND Contaminated blood cultures pose a significant burden by subjecting children to unnecessary testing, procedures, and antibiotics and increasing health care costs. The aim of our quality improvement (QI) initiative was to decrease the percentage of contaminated peripheral blood cultures in our pediatric emergency department (ED) from an average of 6.7% to <3% over a 16-month period. METHODS The QI initiative was implemented in the pediatric ED of a tertiary care children’s hospital. Interventions included change of the peripheral blood culture collection from a clean to a sterile process, nursing education, and individualized feedback. The primary outcome measure was the percentage of contaminated peripheral blood cultures. The process measure was the percentage of nurses who completed 75% to 100% of the steps of the sterile collection process, as measured by self-reporting in audit cards. The balancing measures were time from antibiotic ordering to time of administration and ED length of stay. RESULTS We decreased the percentage of contaminated peripheral blood cultures threefold from a baseline (June 2, 2018, to December 31, 2018) of 6.7% to 2.1% during the intervention period (January 1, 2019, to April 30, 2020). Ninety-eight percent of nurses who completed audit cards reported performing 75% to 100% of the steps of the new sterile process. There was no significant difference in the average time from antibiotic ordering to antibiotic administration or ED length of stay between the baseline and intervention periods. CONCLUSIONS Use of a sterile blood culture collection process, in addition to nursing education and individualized feedback, is an effective method to decrease peripheral blood culture contamination rates in a pediatric ED.

Evaluating the Proportion of Low-Value Blood Cultures Obtained in a Pediatric Emergency Department

“…There was a significant ( P < 0.0001) increase in repeat blood cultures (43% vs 1%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients discharged home and then found to have contaminated blood cultures as compared with those with negative cultures 2 . We reduced contaminated blood cultures obtained in the ED by changing our blood culture collection method 26 . Another strategy to reduce contaminated blood cultures would be to reduce the number of blood cultures obtained, especially those of low value.…”

“…2 We reduced contaminated blood cultures obtained in the ED by changing our blood culture collection method. 26 Another strategy to reduce contaminated blood cultures would be to reduce the number of blood cultures obtained, especially those of low value.…”

Tumor-Derived Exosomes and the Role of Liquid Biopsy in Human Papillomavirus Oropharyngeal Squamous Cell Carcinoma

“…Several institutions have developed and validated HPV ctDNA assays that have proven useful for detecting and tracking trends in the expression of plasma E6 and/or E7 HPV oncogenes in patients with HPV + OPSCC 20,21,55,56 . Although detecting the E6 or E7 open reading frame has a high specificity (roughly 99%) for detecting active disease, its pooled sensitivity is only 65%, suggesting an appreciable rate of false-negative results 24 .…”

“…54 Several institutions have developed and validated HPV ctDNA assays that have proven useful for detecting and tracking trends in the expression of plasma E6 and/or E7 HPV oncogenes in patients with HPV + OPSCC. 20,21,55,56 Although detecting the E6 or E7 open reading frame has a high specificity (roughly 99%) for detecting active disease, its pooled sensitivity is only 65%, suggesting an appreciable rate of false-negative results. 24 In addition, assay sensitivity is decreased with early-stage tumors, underscoring the need for improved liquid biopsy assays capable of reliably detecting early-stage disease, assessing response to therapy, and identifying disease recurrence in HPV + OPSCC.…”