Reducing blood culture contamination in a pediatric emergency department

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Weddle G, Jackson MA, Selvarangan R.
Pediatr Emerg Care. 2011 Mar;27(3):179-81.
Children’s Mercy Hospitals and Clinics, Kansas City, MO

  • Reduced the rate of false-positive peripheral blood cultures by educating staff about hospital policy, using a blood culture-drawing kit, having a dedicated team obtaining peripheral blood cultures, and following up with staff who draw a contaminated peripheral blood culture.
  • The false-positive peripheral blood culture rate in the emergency department dropped from 2.1% to 1.4%.
  • Before intervention, 44 patients were called back to the emergency department, and 25 were admitted because of blood culture contamination. After intervention, a total of 9 patients were called back, and 5 were admitted.

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Reducing blood culture contamination rates in the emergency department

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Harding AD, Bollinger S.
J Emerg Nurs. 2013 Jan; 39(1): e1-6.
Southcoast Hospitals Group, New Bedford, MA, USA

  • Developed and implemented a corrective action plan to lower contamination rates including: private conversations with staff members associated with higher numbers of contaminated draws, ensuring availability of necessary blood culture collection supplies, re-education of all staff surrounding blood culture collection best practices, monthly feedback on blood culture contamination rates, and continuing private conversations as necessary.
  • The average rate of blood culture contamination dropped from 1.82% to 1.01% after the interventions, a 44% decrease in hospital-wide blood culture contamination rates.
  • Annualized cost avoidance of approximately $614,000.

Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and potential effect on central line-associated bloodstream infection reporting

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Boyce JM, Nadeau J, Dumigan D, Miller D, Dubowsky C, Reilly L, Hannon CV.
Infect Control Hosp Epidemiol. 2013 Oct;34(10):1042-7.
Yale-New Haven Hospital, New Haven, Connecticut

  • Evaluated the impact of a new blood culture policy that discouraged drawing blood samples from central lines.
  • The proportion of blood samples obtained for culture from central lines decreased from 10.9% to 0.4%.
  • The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 to 21 (0.5%) of 4,245.
  • Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in CBCs yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010.
  • In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012.

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Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis

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Snyder SR, Favoretto AM, Baetz RA, Derzon JH, Madison BM, Mass D, Shaw CS, Layfield CD, Christenson RH, Liebow EB.
Clin Biochem. 2012 Sep;45(13-14):999-1011.
Battelle Centers for Public Health Research and Evaluation, Associated Laboratory Consultants, Centers for Disease Control and Prevention, University of Maryland, United States

  • Review the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits.
  • All studies for venipuncture and phlebotomy teams favored these practices. For prep kits 6 studies’ effect sizes were not statistically significantly different from no effect.

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Reducing contamination of peripheral blood cultures in a pediatric emergency department

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Murillo TA, Beavers-May TK, English D, Plummer V, Stovall SH.
Pediatr Emerg Care. 2011 Oct;27(10):918-21.
Arkansas Children’s Hospital, Little Rock, AR

  • Determined the ED Contamination rate and evaluate an educational intervention.
  • Positivity rate during the pre-study phase was 6.8%; 114 were contaminants and 40 were pathogens. Positivity rate during the intervention phase was 6.3%; 124 were contaminants and 33 were pathogens.
  • Contamination rates of individual practitioners ranged from 0% to 17% (PRE) and from 0% to 21% (POST).
  • The rate in the ED for peripherally drawn blood cultures is approximately 5% monthly. For each culture positive for organism, the chance of contamination is 75% or higher.

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Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: A Prospective Randomized Crossover Study

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Story-Roller E, Weinstein MP.
J Clin Microbiol. 2016 Dec;54(12):3007-3009.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

  • Of the 6,095 total blood culture sets obtained, 667 (10.94%) were positive and 238 (3.90%) were contaminated.
  • Of the 3,130 blood cultures obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of the 2,965 blood cultures obtained using CHG, 327 (11.03%) were positive, and 115 (3.88%) were contaminated.
  • The rates of contaminated blood cultures between the two antiseptic agents were not different statistically.

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Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial

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Septimus EJ, Hayden MK, Kleinman K, Avery TR, Moody J, Weinstein RA, Hickok J, Lankiewicz J, Gombosev A, Haffenreffer K, Kaganov RE, Jernigan JA, Perlin JB, Platt R, Huang SS.
Infect Control Hosp Epidemiol. 2014 Oct; 35 Suppl 3: S17-22.
Hospital Corporation of America, Nashville, Tennessee.

  • Universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.

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Blood culture contamination: a randomized trial evaluating the comparative effectiveness of 3 skin antiseptic interventions

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Washer LL, Chenoweth C, Kim HW, Rogers MA, Malani AN, Riddell J 4th, Kuhn L, Noeyack B Jr, Neusius H, Newton DW, Saint S, Flanders SA.
Infect Control Hosp Epidemiol. 2013 Jan;34(1):15-21.
University of Michigan Health System

  • The overall blood culture contamination rate for the study population was 0.76%.
  • Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics.

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Blood culture contamination rates after skin antisepsis with chlorhexidine gluconate versus povidone-iodine in a pediatric emergency department

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Marlowe L, Mistry RD, Coffin S, Leckerman KH, McGowan KL, Dai D, Bell LM, Zaoutis T.
Infect Control Hosp Epidemiol. 2010 Feb;31(2):171-6.
University of Pennsylvania School of Medicine, Philadelphia, USA.

  • The blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures after implementation of chlorhexidine, a 30% relative decrease.
  • Skin antisepsis with chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

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