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

Abstract

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.

Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line–associated bloodstream infections

“…Using a fully sterile procedure with a standardized kit that contained sterile gloves and with a large fenestrated drape to create a sterile field resulted in relative decreases of 43% and 64% at 2 EDs 79 A recent cost analysis based on the 2013 study by Self et al compared 3 strategies: usual care in which nurses collected BCs without a standardized protocol, use of kits containing sterile gloves and drapes, or use of phlebotomy teams. 80 Based on a BCC rate of 1.68% when using a sterile kit, the authors determined that the annual savings were $483,219. The strategy of using sterile kits was less costly than usual care.…”

Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage

“…These are best characterized for false positive (contaminated) blood cultures, and are likely in excess of $10,000 per patient with false positive results. 20 Thus, our estimated direct cost calculations may substantially underestimate the true costs associated with indiscriminant microbiological testing. …”

Blood culture contamination rate in an intensive care setting: Effectiveness of an education-based intervention

“…4,5 Several authors have shown the deleterious consequences of false-positive BCs because they induce further testing and prolong hospital stay. [13][14][15][16][17][18][19] It has been estimated that each false positive result carries an economic burden of $4.385-$8.720 when those patients are compared with patients without positive BC. 13,14 It is also possible that the unnecessary use of antibiotic agents in these patients could be a contributor to the genesis of antibiotic resistance in hospital settings.…”

“…13,15,17,18 BC contamination rate reduction has been the focus of several studies conducted in adult and pediatric hospital populations, as well as in emergency services. Education-based interventions, [22][23][24] campaigns to encourage handwashing, 21 the appointment of dedicated phlebotomists to collect samples, 19,25 the prohibition of the use of venous catheters as a source of blood, 14,25,26 and the use of special kits for blood extraction 19,24 have shown positive results. However, in studies of critical care unit patients only the effect of the use of central venous lines as a source of BC have been examined.…”

“…The major human and economic effect of the consequences of a high rate of contamination of BCs has been described. [13][14][15][16][17][18][19] Controlling the BC contamination rate would avoid largely the problem of clinical interpretation of CNS BC. In this sense, some successful interventions in pediatrics, general wards, and emergency departments have been published, but according to our data there are not any specific applications in critical care patients.…”