Reducing blood culture contamination using an initial specimen diversion device

Zimmerman, Frederic S.; Assous, Marc V.; Zevin, Shoshana; Wiener-Well, Yonit

doi:10.1016/j.ajic.2018.12.004

Cited by 21 publications

(28 citation statements)

References 11 publications

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“…BCC events to a greater extent than has been previously observed. [20][21][22][23] Moreover, ours is the first study to address the impact of contamination on false-positive CLABSIs. Notably, phlebotomists performing traditional venipuncture without the ISDD likely had higher BCC rates than RNs because phlebotomists drew most blood samples from inpatients, including those in the intensive care units and those considered to be 'hard stick' patients, whereas RNs drew blood samples primarily from ED patients who overall are not as difficult to draw from.…”

Section: Discussionmentioning

confidence: 96%

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Tompkins

Tien

Madison

2022

Infect. Control Hosp. Epidemiol.

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Objective: To assess the impact of initial specimen diversion device (ISDD) on inpatient and emergency department blood culture contamination (BCC), central-line–associated bloodstream infection (CLABSI) standardized infection ratios (SIRs), and antibiotic administration. Design: Single-center quasi-experimental prospective cohort study wherein phlebotomists used traditional venipuncture with or without the ISDD while registered nurses (RNs) used traditional venipuncture. Method: BCC events among phlebotomists and RNs were observed and compared from March 17, 2019, through January 21, 2020, defined by contaminant detection in 1 of 4 bottles for matched sets or 1 of 2 bottles in both subsets for coagulase negative staphylococci. CLABSIs throughout this period were recorded and SIRs were calculated. Enhanced oversight took place through July 21, 2019, with chart review assessing antibiotic use for patients with possible BCC. Results: Overall, 24% of blood cultures obtained were from patients in intensive care. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate; phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs drew 7,411 BCs with a 0.8% BCC rate. The CLABSI SIR was decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019. The CLABSI incidence was 33%–64% of predicted value for each 2019 quarter. This range fell to 18%–37% after the exclusion of likely false-positive results. Among 42 patients with possible BCC under enhanced oversight, 2 patients were treated with prolonged antibiotic courses. Conclusions: ISDD use by phlebotomists was associated with BCC reduction and reduced false-positive CLABSI results. This patient-care quality improvement could constitute sustainable antibiotic stewardship expansion.

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Section: Discussionmentioning

confidence: 96%

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line–associated bloodstream infections

Tompkins

Tien

Madison

2022

Infect. Control Hosp. Epidemiol.

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“…The 3 prospective controlled studies compared patients who received ISDD with standard of care. These trials were done in different settings, including a community hospital [ 24 ] in the US, an academic ED in the US [ 24 ], and an academic hospital in Israel [ 26 ]. The contamination rate was significantly lower in the ISDD arm (0.22%–1%) compared with the standard of care (1.78%–5.2%) in all 3 trials.…”

Section: Steripath Devicementioning

confidence: 99%

The Impact of Initial Specimen Diversion Systems on Blood Culture Contamination

Mohajer

Lasco

2023

Open Forum Infectious Diseases

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Blood culture contamination is associated with increased antimicrobial use, length of stay, and hospital cost. To address this problem, blood culture diversion has been developed as an additional measure to reduce contamination to targeted goals. Three different versions were proposed, including an open technique and two commercially available devices. This study aims to review the existing literature and analyze evidence for these three techniques.

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“…109 An important aspect of DS is ongoing evaluation of novel devices, such as those designed to reduce blood culture contamination. 110 DS interventions should also be applied to C difficile testing to ensure more appropriate testing, facilitate prompt isolation and optimize clinical treatment. DS interventions related to C difficile testing should include: provision of education of nurses on the appropriate documentation of patient bowel movements and use of laxatives 111 ; implementation of C difficile order sets 112 and EMR best practice alerts to assist providers in avoiding testing when patients do not meet current recommendations (recent laxative use, ˂ 3 unformed stools in 24 hours) 113 ; optimizing testing strategies to distinguish between toxigenic and nontoxigenic strains of C difficile.…”

Section: Diagnostic Stewardshipmentioning

confidence: 99%