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...

The introduction of the CPP significantly improved compliance of hand decontamination, correct usage of gloves and aprons, and overall infection-control in a large teaching hospital. The CPP is a highly effective auditing and educational tool that can be readily adapted for use in hospitals globally to monitor and improve infection-control practices.

The use of catheter maintenance solutions to manage clients whose catheters block has long been a subject for debate. An understanding of the causes of blockage, and awareness of appropriate management may reduce frequency of blockage and reduce unnecessary interruptions to a closed urinary drainage system.

It is estimated that over 90 000 people in the UK community live with an indwelling catheter ( Wilson, 2016 ). It is essential that a lubricating gel is used during catheterisation, as this helps to reduce the risk of pain, trauma and infection ( Loveday et al, 2014 ; National Institute for Health and Care Excellence, 2012 ). Chlorhexidine is an antiseptic contained in many catheterisation gels. Evidence demonstrates that increasing numbers of patients are experiencing hypersensitivity reactions to this ingredient ( Australian and New Zealand College of Anaesthetists, 2014 ). This article considers the range of catheterisation gel choices available to clinicians and the importance of selecting the correct gel for each patient. It addresses the benefits of using OptiLube Active CHG Free (with lidocaine 2%) - the only catheterisation gel currently available in the UK that contains the benefits of local anaesthetic without chlorhexidine - and recommends that this should be the gel of choice for non-specialist staff conducting catheterisations without individual patient assessments.

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