Increasing the volume of blood received in adult paired blood culture bottles at a regional public health laboratory: results of a quality improvement project to optimise the diagnosis of bacteraemia

Birkhamshaw, Edmund; Winzor, Gemma

doi:10.1016/j.infpip.2019.100007

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…Only 36.3% of collected BC bottles fulfilled the recommended BC filling volumes of 8 to 10 mL per bottle. Similar results have been shown in previous studies [6,[17][18][19].…”

Section: Discussionsupporting

confidence: 92%

Factors impacting the pre-analytical quality of blood cultures—Analysis at a tertiary medical center

Romann

Werlen²,

Rommers³

et al. 2023

PLoS ONE

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Background Blood cultures (BC) are critical for the diagnosis of bloodstream infections, pathogen identification, and resistance testing. Guidelines recommend a blood volume of 8–10 mL per bottle as lower volumes result in decreased sensitivity. We aimed to evaluate factors for non-adherence to recommended volumes and assess the effects on diagnostic performance. Methods From February to April 2020, we measured collected blood volumes by weighing all BC containers from inpatient samples at the University Hospital Basel. Information on BC volumes was merged with clinical and microbiological data, as well as nursing staff schedules. We analyzed factors associated with (i) BC sampling volume, (ii) reaching recommended volumes (≥8 mL), (iii) BC positivity, and (iv) time to positivity using linear and generalized linear mixed effect models. Results We evaluated a total of 4’118 BC bottles collected from 686 patients. A total of 1’495 (36.3%) of all bottles contained the recommended filling volume of ≥8 mL. Using a central venous and arterial catheter for drawing blood resulted in an increase of filling volume by 0.26 mL (95% CI 0.10, 0.41) and 0.50 mL (95% CI 0.31, 0.69) compared to peripheral venipuncture, respectively. Each additional nursing staff working at the time of blood drawing was associated with 6% higher odds of achieving the recommended filling volume. We found no significant correlation between the filling volume and the positivity rate. Conclusion Our results indicate critical pre-analytical quality markers linked to BC collection procedures to reach recommended collection volumes. No significant impact on the positivity rate was found.

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“…Only 36.3% of collected BC bottles fulfilled the recommended BC filling volumes of 8 to 10 mL per bottle. Similar results have been shown in previous studies [6,[17][18][19].…”

Section: Discussionsupporting

confidence: 92%

Factors impacting the pre-analytical quality of blood cultures—Analysis at a tertiary medical center

Romann

Werlen²,

Rommers³

et al. 2023

PLoS ONE

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“…[16][17][18] Automated BC volume measurements have enabled largerscale feedback and education interventions across several healthcare systems showing reduced BC underfilling, in some cases associated with increased BC true positivity rate. [19][20][21] The incidence of solitary BC sets in the ED has been shown to range from 16.9% to >90% 9,22 and from a wider hospital perspective 48% to 94%. 23,24 Despite this, published interventions to reduce solitary BC are few.…”

Section: Discussionmentioning

confidence: 99%

“…Improvement in BC bottle volumes has been achieved through education and feedback for phlebotomist teams in several hospitals 16–18 . Automated BC volume measurements have enabled larger‐scale feedback and education interventions across several healthcare systems showing reduced BC underfilling, in some cases associated with increased BC true positivity rate 19–21 …”

Section: Discussionmentioning

confidence: 99%

Changing culture: An intervention to improve blood culture quality in the emergency department

Williams,

Hills,

Ray

et al. 2023

Emerg Medicine Australasia

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ObjectiveBlood cultures (BCs) remain a key investigation in ED patients at risk of bacteraemia. The aim of this study was to assess the effect of a multi‐modal, nursing‐led intervention to improve the quality of BCs in the ED, in terms of single culture, underfilling and contamination rates.MethodThe present study was conducted in the ED of a large urban tertiary referral hospital. The study included four phases: pre‐intervention, intervention, post‐intervention and sustainability periods. A multi‐modal intervention to improve BC quality consisting small group education, posters, brief educational videos, social media presence, quality feedback, small group/individual mentoring and availability of BC collection kits was designed and delivered by two senior ED nurses over 7 weeks. Study data comprised rates of single, underfilled and contaminated cultures in each of three 18‐week periods: pre‐intervention (baseline), post‐intervention and sustainability.ResultsOver the study period 4908 BC sets were collected during 2347 episodes of care in the ED. Single culture sets reduced from 56.2% in the pre‐intervention period to 22.8% post‐intervention (P < 0.01) and 18.8% in the sustainability period (P < 0.01). Underfilled bottle rates were also significantly reduced (aerobic 52.8% pre‐intervention to 19.2% post‐intervention, 18.8% sustainability, anaerobic 46.8% pre‐intervention to 23.3% post‐intervention, 23.8% sustainability). Skin contaminants were grown from 3.7% of BC sets in the pre‐intervention period, improving to 1.5% in the post‐intervention period (P < 0.001) and 2.1% in the sustainability period (P = 0.03). Total volume of blood cultured was significantly associated with diagnosis of bacteraemia.ConclusionSignificant improvements in BC quality are possible with nursing‐based interventions in the ED.

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“…Furthermore, some studies have applied AV data from the BACTEC™FX system as an index to monitor blood culture volume in hospitals. [ 2 , 24 ] Although it may be a substitute, the BACTEC™FX system cannot reflect the real problem in blood culture collection, as it only offers the average blood volume of the sampling department. We could not determine the number of blood culture bottles with a volume lower than the recommended volume.…”

Section: Discussionmentioning

confidence: 99%

Revisiting factors associated with blood culture positivity: Critical factors after the introduction of automated continuous monitoring blood culture systems

et al. 2022

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Blood culture is the main tool used to identify causative pathogens. Adequate volume and number of culture sets are considered key to blood culture positivity rate. It is not known whether these factors remain critical to the positivity rate after the introduction of automated continuous blood culture system monitoring.We measured blood volume per bottle and described the distribution of blood volume and number of culture sets. Multivariate logistic regression was performed to determine the independent association of blood volume, number of culture sets, diagnosis of sepsis in a patient, and other covariates with blood culture results.Only 6.9% of the blood culture bottle volumes complied with the guidance (8-10 mL), with the highest culture positivity rate (18%). Of the culture events, only one set of blood was cultured in 60.9% of events. In the multivariate analysis, blood culture volume per event (odds ratio [OR], 1.09 [95% confidence interval [CI], 1.06-1.11]), patients with a diagnosis of sepsis (OR, 2.86 [95% CI, 2.06-3.98]), and samples from the emergency department (OR, 2.29 [95% CI, 1.72-3.04]), but not the number of culture sets (OR, 0.74 [95% CI, 0.50-1.12]), were observed to be statistically significant with respect to blood culture positivity rate.Our results revealed that the total blood culture volume and the diagnosis of sepsis were critical factors affecting blood culture positivity rate. However, the proportion of blood culture bottles with the optimal blood volume was very low, and optimizing blood volume would be key to increasing blood culture positivity rate.

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Increasing the volume of blood received in adult paired blood culture bottles at a regional public health laboratory: results of a quality improvement project to optimise the diagnosis of bacteraemia

Cited by 6 publications

References 6 publications

Factors impacting the pre-analytical quality of blood cultures—Analysis at a tertiary medical center

Factors impacting the pre-analytical quality of blood cultures—Analysis at a tertiary medical center

Changing culture: An intervention to improve blood culture quality in the emergency department

Revisiting factors associated with blood culture positivity: Critical factors after the introduction of automated continuous monitoring blood culture systems

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