Blood Culture Collection through Peripheral Intravenous Catheters Increases the Risk of Specimen Contamination among Adult Emergency Department Patients

Self, Wesley H.; Speroff, Theodore; McNaughton, Candace D.; Wright, Patty W.; Miller, Geraldine G.; Johnson, James G.; Daniels, Titus L.; Talbot, Thomas R.

doi:10.1086/665319

Cited by 29 publications

(29 citation statements)

References 10 publications

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“…Due to problems with compliance, pain, the difficulty of venipuncture, and the desire to prevent needle-stick injury in pediatric patients, blood culture specimens are often obtained simultaneously with intravenous catheter insertion, rather than being obtained via separate venipuncture. The contamination rate of culture specimens drawn via venipuncture from a separate site has been shown to be significantly lower than the rate obtained via a newly inserted intravenous catheter in children with suspected bacteremia1,14,15). However, other studies have shown no significant difference in contamination rates between catheter- and venipuncture-drawn blood cultures.…”

Section: Discussionmentioning

confidence: 95%

Blood culture contamination in hospitalized pediatric patients: a single institution experience

et al. 2014

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PurposeBlood culture is the most important tool for detecting bacteremia in children with fever. However, blood culture contamination rates range from 0.6% to 6.0% in adults; rates for young children have been considered higher than these, although data are limited, especially in Korea. This study determined the contamination rate and risk factors in pediatric patients visiting the emergency room (ER) or being admitted to the ward.MethodsWe conducted a retrospective chart review of blood cultures obtained from children who visited Yonsei Severance Hospital, Korea between 2006 and 2010. Positive blood cultures were labeled as true bacteremia or contamination according to Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for laboratory-confirmed bloodstream infection, after exclusion of cultures drawn from preexisting central lines only.ResultsAmong 40,542 blood cultures, 610 were positive, of which 479 were contaminations and 131 were true bacteremia (overall contamination rate, 1.18%). The contamination rate in the ER was significantly higher than in the ward (1.32% vs. 0.66%, P<0.001). The rate was higher in younger children (2.07%, 0.94%, and 0.61% in children aged <1 year, 1-6 years, and >6 years, respectively).ConclusionOverall, contamination rates were higher in younger children than in older children, given the difficulty of performing blood sampling in younger children. The contamination rates from the ER were higher than those from the ward, not accounted for only by overcrowding and lack of experience among personnel collecting samples. Further study to investigate other factors affecting contamination should be required.

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Section: Discussionmentioning

confidence: 95%

Blood culture contamination in hospitalized pediatric patients: a single institution experience

et al. 2014

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“…21–23 This allowed nurses and paramedics to widely palpate throughout their procedural fields to find an optimal location for venipuncture without introducing contaminants from the patient’s adjacent skin, their own fingers, or venous catheters. 24 From a human factors perspective, 25 we believe the sterile blood culture kit was successful in reducing contamination by providing the optimal equipment for nurses and paramedics to use the most natural technique for finding a venipuncture site—feeling the target vein with the index finger of the non-dominant hand while inserting a needle into the vein with the dominant hand (Figure 2b). …”

Section: Discussionmentioning

confidence: 99%

Reducing Blood Culture Contamination in the Emergency Department: An Interrupted Time Series Quality Improvement Study

Self

Speroff

Grijalva

et al. 2013

Academic Emergency Medicine

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Objectives Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED. Methods The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure, to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university-affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48-week baseline period (clean technique), and 48-week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first-order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%. Results During the baseline period, 321 out of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% CI = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period. Conclusions A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.

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“…10 Commonly, nurses collect these specimens using non-sterile gloves, alcohol skin antisepsis, and either peripheral venipuncture or a blood draw through an existing peripheral intravenous catheter. 10,20 Training for ED nurses on blood culture collection frequently includes initial bedside mentoring by a senior nurse during orientation to the unit and annual training workshops. 10,11 Individual-level feedback on contamination rates is not typical.…”

Section: Methodsmentioning

confidence: 99%

Cost Analysis of Strategies to Reduce Blood Culture Contamination in the Emergency Department: Sterile Collection Kits and Phlebotomy Teams

Self

Talbot²,

Paul³

et al. 2014

Infect. Control Hosp. Epidemiol.

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Objective Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase upfront costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with three collection strategies: usual care, sterile kits, and phlebotomy teams. Design Cost analysis. Setting This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. Methods Total hospital costs associated with three strategies were compared: (1) usual care with nurses collecting cultures without a standardized protocol; (2) sterile kits with nurses using a dedicated sterile collection kit; (3) phlebotomy teams with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results—negative, true positive, and contaminated. Results Compared to usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses. Conclusions EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

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Blood Culture Collection through Peripheral Intravenous Catheters Increases the Risk of Specimen Contamination among Adult Emergency Department Patients

Cited by 29 publications

References 10 publications

Blood culture contamination in hospitalized pediatric patients: a single institution experience

Blood culture contamination in hospitalized pediatric patients: a single institution experience

Reducing Blood Culture Contamination in the Emergency Department: An Interrupted Time Series Quality Improvement Study

Cost Analysis of Strategies to Reduce Blood Culture Contamination in the Emergency Department: Sterile Collection Kits and Phlebotomy Teams

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