A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children’s Hospital

Feghaly, Rana E. El; Chatterjee, Jahnavi; Dowdy, Kristin; Stempak, Lisa; Morgan, Stephanie; Needham, William P.; Prystupa, Kesha; Kennedy, M.T.

doi:10.1542/peds.2018-0244

Cited by 26 publications

(29 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…BC contaminations are not uncommon. Despite the standard recommendation for 3% BC contamination rate usually the reports are above this level and vary significantly even reaching 12% (4,5). The high fluctuation in BC contamination rate reported is partially due to the lack of uniformity since some authors decide themselves whereas others rely on the contributing microbiologist's decision on the contaminant status of an isolate (4).…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the major clinical impact of BC contaminations and the relevant alteration in the clinical treatment algorithms, the overall additional cost burden due to BC contaminations is very high and is estimated as a median of $8,720( 8 ). Among others this cost is due to increased length of stay (estimated as a median 4.5-day increase in North America), increased microbiology laboratory charges and increased antibiotic use ( 4 , 5 ). In the first nine months of the present study all isolates including all possible contaminants were fully processed thus allowing the clinicians to decide themselves whether the presence of a possible contaminant in the blood was of clinical importance or not.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reduction in the processing of possible blood culture contaminants by the application of a selection criterion

2020

View full text Add to dashboard Cite

Possible blood culture (BC) contaminants are generally considered to be skin flora species including coagulase-negative Staphylococci (CNS), Corynebacterium species, Micrococcus species, Bacillus species and Propionibacterium acnes. Prior to October 1, 2016 all possible BC contaminants were fully processed (identification, susceptibility testing) in our laboratory. In order to reduce the laboratory workload from October 1, 2016 a possible contaminant was only processed if it was present in more than one BC pair drawn from the same patient within the same day. The two-year study period was divided in two periods namely period A from January 1, 2016 to September 30, 2016 (first 9 months) and period B from October 1, 2016 to December 31, 2017 (last 15 months). A series of indices (INs) were calculated including among others the Working Rate IN (WR) defined as the total isolates divided to the total number of BCs submitted per month and the CNS Rate (CNSR) defined as the total number of CNS processed divided to the total number of BCs submitted per month. A 23.08% reduction in the CNSR was noted (from 3.51% in period A to 2.70% in period B) whereas the overall WR was reduced from 7.19% in period A to 6.84% in period B. Furthermore, the total number of contaminants processed per month divided to the total number of isolates processed per month was reduced from 54.50% in period A to 42.41% in period B. The reduction in the INs recorded is of great value since it was achieved by the implementation of a simple criterion easily applicable and without any cost.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reduction in the processing of possible blood culture contaminants by the application of a selection criterion

2020

View full text Add to dashboard Cite

show abstract

“…In general, health care workers obtaining blood cultures need to be well trained and blood culture collection protocols should be repeatedly emphasized. Feghaly et al describe lower contamination rates by enhancing training and standardizing protocols [15]. Kirn et.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic resistance of blood cultures in regional and tertiary hospital settings of Tyrol, Austria (2006-2015): Impacts & trends

Kreidl

Kirchner²,

Fille

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

Blood stream infections rank among the top seven causes of death of the general population. The aim of our study was to better understand the epidemiology of BSI in order to improve diagnostics and patient outcome. We used retrospective aggregated laboratory data of blood samples received from all public hospitals in Tyrol, Austria between 2006 and 2015. Microorganisms were categorized into obligatory, facultative, unusual pathogens and contaminants. The distribution, the cumulative incidence and antimicrobial susceptibility patterns were compared between the tertiary (TH) and regional peripheral hospitals (PH). Among 256,364 blood samples, 76.1% were from the TH The incidence of obligatory pathogens was 1.7 fold, and up to 3 times higher for facultative, unusual pathogens and contaminants in the TH and increased mainly due to an increase of E.coli, which was the most common isolated pathogen (n = 2,869), followed by Staphylococcus aureus (n = 1,439), Enterococcus sp. (n = 953) and Klebsiella sp. (n = 816). The distribution of obligatory pathogens differed between the hospital settings: In the TH Enterococcus sp. accounted for 40.8% and E.coli for 70.4%, respectively, whereas in the PH for 25.4% (p<0.0001) and 57.8%, respectively (p<0.0001) Antibiotic resistance of Gram negative bacteria and Staphylococcus aureus did not change during the observation period. Carbapenem resistance of Klebsiella sp. and vancomycin and linezolid resistance of Enterococcus faecium showed a non-significant increase since 2010 in the TH setting. We concluded that the incidence of BSI in TH was higher compared to PH. We observed higher contamination rates in the TH. We could not interpret the data of coagulase negative staphylococci due to lack of clinical data. We strongly recommend enhancement of training on blood culture sampling to decrease the rate of contamination. Due to differences in pathogen distribution and antimicrobial resistance between different hospital settings we recommend separate treatment guidelines for BSI by hospital setting.

show abstract

“…5,20,21 The documented contamination rate in pediatric centers ranges from 1.32 to 10%, 1,3,22 and is associated with the skin antiseptics used, training of the venipuncture team, the protocol used, young patient age, and the experience of those obtaining the culture. 3,5,8,22,23 Contamination rate decreased with the changing of disinfectants 24 and with the development of trained venous puncture teams and protocols. 7,23 In the present study, however, the variables of infancy and lower resident experience were not a risk factor for contamination.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,8,22,23 Contamination rate decreased with the changing of disinfectants 24 and with the development of trained venous puncture teams and protocols. 7,23 In the present study, however, the variables of infancy and lower resident experience were not a risk factor for contamination. It is possible that the difference between the present retrospective, cross-sectional study and other reports is associated with the intensive education at the present hospital.…”

Section: Discussionmentioning

confidence: 99%

Skin preparation for prevention of peripheral blood culture contamination in children

Yodoshi

Ueda

Goldman

2019

Pediatrics International

View full text Add to dashboard Cite

Background In Japan, blood cultures for children are performed by pediatric residents, and povidone‐iodine (PI) is the recommended solution for skin preparation. Given that PI needs to be applied for 1.5–2 min before venipuncture, skin preparation may be suboptimal if this is not followed. In this study, we investigated the blood culture contamination rate after skin preparation with only 70% isopropyl alcohol (IPA) or IPA plus PI. Methods We performed a retrospective study of patients aged ≤6 years who provided blood cultures in the emergency department or pediatric ward. Patients with indwelling central venous catheter were excluded. We evaluated the impact of changing the method of skin preparation, comparing the traditional method using IPA plus PI between 2008 and 2010 (IPA + PI group) with the simplified method using only IPA between 2015 and 2017 (IPA group). Results A total of 5,365 blood culture samples were eligible for this study. Of these, 171 (3.2%) had an organism identified in blood culture. Of the blood culture‐positive samples, 68 (1.3%) were true positive and 103 (1.9%) were contaminated. Thirty‐eight (1.6%) of 2,407 cultures in the IPA group were contaminated, whereas 65 (2.2%) of 2,958 cultures in the IPA + PI group were contaminated (OR, 0.72; 95%CI: 0.48–1.07; P = 0.1). Coagulase‐negative Staphylococcus grew significantly less in the IPA group (1.7% vs 1.0%, P = 0.02). Conclusions A single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures from children in Japan.

show abstract

A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children’s Hospital

Cited by 26 publications

References 37 publications

Reduction in the processing of possible blood culture contaminants by the application of a selection criterion

Reduction in the processing of possible blood culture contaminants by the application of a selection criterion

Antibiotic resistance of blood cultures in regional and tertiary hospital settings of Tyrol, Austria (2006-2015): Impacts & trends

Skin preparation for prevention of peripheral blood culture contamination in children

Contact Info

Product

Resources

About