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

Zainab Raouf
St. Vincent’s University Hospital in Dublin, Ireland
Poster #52 – Beyond the needle: innovative approaches for reducing blood culture contamination rates in the emergency department. Emergency Medicine Journal 41(Suppl 2): A11.2-A12 October 2024.

Introduction
Blood cultures are diagnostic tests performed to screen for systemic infections/sepsis. Positive blood cultures aid healthcare professionals in identifying the causative pathogens, enabling a timely and targeted intervention with the most effective antimicrobial therapy. The Emergency Department (ED) encounters daily challenges with blood culture contaminations. False-Positive Rates (FPR) hinder pathogen identification and increase hospital costs. To address this, we utilized the innovative Kurin Lock-Initial Specimen Diversion (Kurin-ISD) device to optimize the collection process, isolating the initial 0.15ml of blood, and discarding potential contaminants. The aim of this study is to reduce the incidence of FPRs.

Methods
A three-phase intervention study design was employed at St. Vincent’s University Hospital in Dublin, Ireland; spanning twelve weeks from September-October 2022 (pre-intervention), September-October 2023 (intervention), and December 2023-January 2024 (post-intervention). The pre-intervention data was collected from the predefined 2022 period. A retrospective analysis of the contaminated versus uncontaminated results facilitated the FPR calculation. The intervention phase introduced the Kurin Lock-ISD device and the use of ChloraPrep for blood culture collection. FPR data was prospectively audited and compared to the corresponding months in the preceding year using the chi-square test. The post-intervention phase withdrew all Kurin Lock-ISD devices, allowing the ED to resume its pre-intervention blood culture collection practices. FPR data was prospectively audited.

Results
We report a significant reduction in FPRs from 18.4% in 2022 to 4.9% in 2023 (χ2 = [12111], p < 0.001), with a recurrence of 17.6% once the device was withdrawn, proving the intervention’s efficacy.

Conclusion
This intervention demonstrated a substantial reduction in FPRs through the synergistic application of the novel Kurin-ISD device and ChloraPrep in a large ED. These results endorse evidence-based strategies for reducing contaminations and improving patient care quality. The intervention’s cost-effectiveness supports potential adoption in similar healthcare settings.

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