Beyond the needle: innovative approaches for reducing blood culture contamination rates in the emergency department

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Kenny S, Raouf Z, Sheridan A, McCarthy I, Rothwell-Kelly G, Menzies D, Schaffer K.
St. Vincent’s University Hospital, Dublin, Ireland
Ir Med J. 2025:118(8); P142

Aim
This quality improvement project aimed to evaluate the effectiveness of the Kurin Lock device, which diverts the initial 0.15 mL of blood, and ChloraPrep (2% alcoholic chlorhexidine) in reducing blood culture contamination rates in emergency departments.

Methods
The study was conducted across three phases: pre-intervention, intervention, and postintervention. Before the intervention, alcohol or chlorhexidine wipes were used for skin antisepsis. The intervention phase introduced the Kurin Lock device and ChloraPrep, accompanied by staff training. Contamination rates were analyzed using the chi-square test.

Results
During the intervention phase, contamination rates significantly decreased from 18.4% (preintervention) to 4.9% (p < 0.001). However, in the post-intervention phase, contamination rates rebounded to 18.1%.

Discussion
The study demonstrates that combining specimen diversion systems with enhanced antisepsis protocols effectively reduces blood culture contamination. However, maintaining these improvements over time remains a challenge, emphasizing the need for sustained adherence to the intervention.

Excerpt: “Blood specimen diversion systems, such as the Kurin Lock device, effectively reduce contamination by diverting the initial blood sample likely to contain skin contaminants, a method well-supported in the literature.  A recent review further highlights their role in improving diagnostic precision.[Al Mohajer M and Lasco T. Open Forum Infect Dis. 2023] In April 2024 the National Institute for Health and Care Excellence (NICE) issued Medical Technologies Guidance 77, which recommends blood diversion systems such as Kurin Lock for EDs with contamination rates > 2.4 %, providing a strong policy mandate for their use.”

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