The practice of blood volume submitted for culture in a neonatal intensive care unit

Singh, Moni Pankhuri; Balegar, Kiran Kumar; Angiti, Rajeshwar Reddy

doi:10.1136/archdischild-2019-318080

Cited by 19 publications

(6 citation statements)

References 25 publications

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“…At the other end of the age spectrum, two interventional studies have shown that it is possible to make significant improvements in the NNU median volume submitted, with our post-intervention median of 0.95 ml in line with other reports [ 33 , 34 ]. In combination with a feasibility study [ 35 ], these studies show it is generally possible to obtain 1 ml even in the smallest infants, and we plan to emphasize this higher threshold in our guidance update.…”

Section: Discussionsupporting

confidence: 91%

Pediatric blood cultures—turning up the volume: a before and after intervention study

Whelan,

Mulrooney,

Moriarty

et al. 2024

Eur J Pediatr

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The major determinant of blood culture (BC) diagnostic performance is blood volume, and pediatric sample volumes are frequently low. We aimed to assess BC volumes in our institution, design an intervention to increase volumes, and assess its impact. All pediatric BCs submitted over a 7-month period to the microbiology laboratory in a university hospital (including emergency department, pediatric ward, and neonatal unit) were included. A pre-intervention period assessed current practice. A multi-faceted intervention (education, guideline introduction, active feedback strategies) was collaboratively designed by all stakeholders. Impact was assessed in a post-intervention period. The main outcome measures included the percentage of samples adequately filled using three measures of sample adequacy (1) manufacturer-recommended minimum validated volume—> 0.5 ml, (2) manufacturer-recommended optimal minimum volume—> 1.0 ml, (3) newly introduced age-specific recommendations. Three hundred ninety-eight pre-intervention and 388 post-intervention samples were included. Initial volumes were low but increased significantly post-intervention (median 0.77 ml vs. 1.52 ml), with multivariable regression analysis estimating volumes increased 89% post-intervention. There were significant increases in all measures of volume adequacy, including an increase in age-appropriate filling (20.4–53.1%), with less improvement in those aged > 3 years. Overall, 68.4% of pathogens were from adequately filled cultures, while 76% of contaminants were from inadequately filled cultures. A pathogen was detected in a higher proportion of adequately filled than inadequately filled cultures (9.4% vs. 2.2%, p < 0.001). Conclusion: Blood volume impacts BC sensitivity, with lower volumes yielding fewer pathogens and more contaminants. Focused intervention can significantly improve volumes to improve diagnostic performance. What is Known:• Blood volume is the major determinant of blood culture positivity, and yet pediatric blood culture volumes are frequently low, resulting in missed pathogens and increased contamination. What is New:• Adequately filled (for age) blood cultures have a pathogen detection rate three times higher than inadequately filled blood cultures.• This interventional study shows that collaboratively designed multi-modal interventions including focus on accurate volume measurement can lead to significant increases in blood volumes and improve blood culture diagnostic performance.

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Section: Discussionsupporting

confidence: 91%

Pediatric blood cultures—turning up the volume: a before and after intervention study

Whelan,

Mulrooney,

Moriarty

et al. 2024

Eur J Pediatr

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“…This concern is not speculative because surprisingly low inoculant volumes have been reported by several studies. 22 , 23 The efficacy of real-time bedside verification of blood volumes sent for culture may cause negative culture results to be more trustworthy. Thus, patients treated during the post-intervention period of this study were more likely to be administered antibiotics for <72 hours.…”

Section: Discussionmentioning

confidence: 99%

Effect of Serial Clinical Observation Complemented by Point-of-Care Blood Culture Volume Verification on Antibiotic Exposure in Newborns

Wawrzoniak,

Romańska

2024

Global Pediatric Health

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Objective. This study evaluated the effects of serial clinical observation strategy complemented by point-of-care verification of blood culture volume in managing term and near-term newborns at risk for early-onset sepsis. Methods. We used a “before-and-after” approach. Infants born at ≥35 0/7 weeks’ gestation were eligible. Our strategy was based on serial clinical observation complemented with point-of-care verification of blood culture volume. Two separate 12-month periods were analyzed. The number of infants exposed to antibiotics started during the first 3 days of life was compared before and after introducing the strategy. Results. During the post-intervention period, 0.6% of infants received antibiotic therapy, compared to 4.1% during the pre-intervention period ( P < .001; relative risk [RR]: 0.15; 95% CI: 0.08-0.28). Conclusion. Serial clinical observation complemented with verification of blood culture volume might reduce antibiotic utilization in newborns in the early postnatal period.

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“…24,25 Several reports of formal quality initiatives focused on NICU blood culturing have shown that such efforts can improve beside processes, reduce blood culture contamination, increase sample volumes, and minimize error in a sustainable way regardless of the level of neonatal care. 9,26,27 No single national standard that addresses all meaningful components of blood drawing, training, and contamination reporting in the NICU is available. Such a document would be a useful tool for this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California

Lefrak

Schaffer

Bohnert

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To describe variation in blood culture practices in the neonatal intensive care unit (NICU). Design: Survey of neonatal practitioners involved with blood culturing and NICU-level policy development. Participants: We included 28 NICUs in a large antimicrobial stewardship quality improvement program through the California Perinatal Quality Care Collaborative. Methods: Web-based survey of bedside blood culture practices and NICU- and laboratory-level practices. We evaluated adherence to recommended practices. Results: Most NICUs did not have a procedural competency (54%), did not document the sample volume (75%), did not receive a culture contamination report (57%), and/or did not require reporting to the provider if <1 mL blood was obtained (64%). The skin asepsis procedure varied across NICUs. Only 71% had a written procedure, but ≥86% changed the needle and disinfected the bottle top prior to inoculation. More than one-fifth of NICUs draw a culture from an intravascular device only (if present). Of 13 modifiable practices related to culture and contamination, NICUs with nurse practitioners more frequently adopted >50% of practices, compared to units without (92% vs 50% of units; P < .02). Conclusions: In the NICU setting, recommended practices for blood culturing were not routinely performed.

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The practice of blood volume submitted for culture in a neonatal intensive care unit

Cited by 19 publications

References 25 publications

Pediatric blood cultures—turning up the volume: a before and after intervention study

Pediatric blood cultures—turning up the volume: a before and after intervention study

Effect of Serial Clinical Observation Complemented by Point-of-Care Blood Culture Volume Verification on Antibiotic Exposure in Newborns

Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California

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