Contamination Rates of Blood Cultures Obtained by Dedicated Phlebotomy vs Intravenous Catheter

Norberg, Alonna; Christopher, Norman C.; Ramundo, Maria; Bower, John R.; Berman, Shirley A.

doi:10.1001/jama.289.6.726

Cited by 125 publications

(94 citation statements)

References 27 publications

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“…However, the sample size of the arterial group comprised only 5% (41/ 843) of all blood draws and hence was not large enough to contribute to statistical significance. Moreover, these results conflict with data from past studies which indicate that blood cultures obtained from vascular catheters are more likely to be contaminated than percutaneously obtained cultures, due to difficulty in sterilizing catheters (7,13). Past studies on blood draws from arterial lines as a source for blood cultures indicate that their results are not associated with higher diagnostic yields than venous blood cultures and are not recommended (11).…”

Section: Discussionmentioning

confidence: 86%

Effects of Volume and Site of Blood Draw on Blood Culture Results

Gonsalves

Cornish

Moore³

et al. 2009

J Clin Microbiol

101

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Blood culture contamination greatly affects clinical decisions. Hence, it is of interest to assess the influence of factors such as the volume of blood drawn and the site of blood draw on the rates of blood culture contamination. In a retrospective study, blood cultures from infants and children up to 18 years of age who had at least one positive blood culture during the year 2006 were analyzed for their volume of blood drawn, patient's weight, site of blood draw used, and blood culture results. Blood cultures were deemed adequate collections if they contained an appropriate weight-related volume of blood. Moreover, blood culture results were categorized as true pathogens, contaminants, and negative cultures; these were then compared and analyzed with respect to their volume and site of blood draw. A total of 5,023 blood cultures were collected during 2006, of which 843 were analyzed. There were 306 (36%) positive cultures among the 843 cultures analyzed. Of the 306 positive cultures, 98 (32%) were contaminants and 208 (68%) cultures grew significant pathogens. Thirty-five percent of the contaminant cultures had adequate volume compared to 60% in the true bacteremia group (P < 0.001). Also, of the 843 cultures, the rates of contamination among the different sites of blood draw were as follows: peripheral venipuncture, 36%; arterial, 10%; and central venous access, 7% (P ‫؍‬ 0.155). The rate of contamination was higher with lower blood volumes, and there was no significant difference in the rates of contamination among the different sites of blood draw.Blood cultures are vital for identifying pathogens causing serious infections and in directing appropriate antibiotic therapy. Moreover, they remain the standard method for detecting bacteremia in the evaluation of sick patients (14). Unfortunately, blood culture contamination is a common occurrence and may lead to confusion regarding the significance of a positive blood culture. The most common contaminants are coagulase-negative staphylococcus species which are also becoming more prevalent as a primary pathogen in immunocompromised patients and in patients with indwelling intravascular devices (9, 15). The uncertain clinical significance of potential contaminants leads to longer hospital stays, unnecessary antibiotic therapy, and additional laboratory testing; as a result, the cost incurred by a hospital is many times that incurred by the laboratory (2).Many factors influence the yield of blood cultures, but the single most important factor is blood volume. Several studies have shown that the rate of isolation of pathogens from blood cultures increases with the quantity of blood submitted (12). Hence, a blood culture may be falsely negative from an inadequate-volume blood culture (6). Furthermore, the blood culture contamination rate inversely correlates with the volume of blood (3). The site and method of blood collection have also been known to influence the rate of contamination of blood cultures (8). Vascular-access devices, such as arterial and central venou...

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Section: Discussionmentioning

confidence: 86%

Effects of Volume and Site of Blood Draw on Blood Culture Results

Gonsalves

Cornish

Moore³

et al. 2009

J Clin Microbiol

101

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“…Patients may experience unnecessary hospitalizations or extended lengths of stay (LOS) with consequent financial burdens (3,4). False-positive cultures may lead to errors in clinical interpretation (13), administration of unnecessary antimicrobial therapy (9), and the need for additional cultures and other diagnostic tests (10). The workload of technologists and other staff (2,14) as well as overall health care costs (2, 16) may increase.…”

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confidence: 99%

Impact of Blood Cultures Drawn by Phlebotomy on Contamination Rates and Health Care Costs in a Hospital Emergency Department

Byrd²,

et al. 2009

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We conducted a prospective comparison of blood culture contamination rates associated with dedicated phlebotomists and nonphlebotomy staff in the emergency department (ED) at Parkland Memorial Hospital in Dallas, TX. In addition, hospital charges and lengths of stay were determined for patients with negative, false-positive, and true-positive blood culture results. A total of 5,432 blood culture collections from two ED areas, the western wing of the ED (ED west) and the nonwestern wing of the ED (ED nonwest), were evaluated over a 13-month period. Phlebotomists drew 2,012 (55%) of the blood cultures in ED west while nonphlebotomy staff drew 1,650 (45%) in ED west and 1,770 (100%) in ED nonwest. The contamination rates of blood cultures collected by phlebotomists were significantly lower than those collected by nonphlebotomists in ED west Blood cultures are the most direct method for detecting bacteremia in patients (12). However, interpretation of blood culture results may be complicated by recovery of bacteria that are potential contaminants. False-positive cultures comprise up to half of all positive blood cultures in adult patients (1,18).Contaminated cultures significantly impact patients, hospital staff, and health care costs. Patients may experience unnecessary hospitalizations or extended lengths of stay (LOS) with consequent financial burdens (3,4). False-positive cultures may lead to errors in clinical interpretation (13), administration of unnecessary antimicrobial therapy (9), and the need for additional cultures and other diagnostic tests (10). The workload of technologists and other staff (2, 14) as well as overall health care costs (2, 16) may increase.Strategies to decrease blood culture contamination rates have included the use of specific disinfection materials (13, 20), educational interventions (7,9,20), collection from separate venipuncture sites (4, 10, 11), the use of the outmoded doubleneedle technique (4), and reliance on specially trained staff or dedicated phlebotomists (4,16,20). A previous study in the Parkland emergency department (ED) replaced povidoneiodine with ChloraPrep antiseptic but did not reduce contamination rates (data not shown). Areas of the hospital such as the ED present special challenges during attempts to reduce blood culture contamination. In the ED, many unique factors impact contamination rates: rapid staff turnover, limited staff to handle high patient census, the nature of presenting patients, and multiple emergencies which may rush the collection of blood samples (1, 9).A prospective study was conducted at Parkland Memorial Hospital, a large county teaching hospital, to determine whether the addition of phlebotomists in the ED would significantly lower blood culture contamination rates. Contamination rates were compared between phlebotomists and nonphlebotomists in the ED every 3 months for a 13-month period. In addition, the financial impact of false-positive blood cultures was analyzed by comparing incremental charge differences and LOS between patients with...

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“…When dealing with blood cultures, contamination is an issue that must be taken into consideration. Contamination is significant when blood cultures are drawn from a catheter in use, as compared to an adequately obtained sample from a peripheral vein [46][47][48][49][50] . On the other hand, diagnostic accuracy is optimal when quantitative paired blood cultures (concomitant catheter and peripheral) are drawn 51,52 .…”

Section: Diagnosismentioning

confidence: 99%

Catheter-Related Bloodstream Infections in Critical Care

Pérez¹

2012

Sepsis - An Ongoing and Significant Challenge

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Contamination Rates of Blood Cultures Obtained by Dedicated Phlebotomy vs Intravenous Catheter

Cited by 125 publications

References 27 publications

Effects of Volume and Site of Blood Draw on Blood Culture Results

Effects of Volume and Site of Blood Draw on Blood Culture Results

Impact of Blood Cultures Drawn by Phlebotomy on Contamination Rates and Health Care Costs in a Hospital Emergency Department

Catheter-Related Bloodstream Infections in Critical Care

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