Centers for Disease Control and Prevention
Blood Culture Contamination: An Overview for Infection Control and Antibiotic Stewardship Programs Working with the Clinical Laboratory
In offering guidance, the CDC references a study by Doern et al which identifies ways to address blood culture contamination. Among the preventive actions, the authors call for the use of diversion devices saying, “There are devices that are commercially available that have shown promise in further reducing blood culture contamination rates. These devices initially divert a small amount of potentially contaminated blood and then collect blood for the blood culture.”
Read the full guidance: Blood Culture Contamination: An Overview for Infection Control and Antibiotic Stewardship Programs Working with the Clinical Laboratory
Centers for Medicare and Medicaid (CMS)
Published a final rule 42 C.F.R § 482.42
Since early 2020, the CMS Conditions of Participation has required hospitals to “demonstrate adherence to nationally recognized infection prevention and control guidelines for reducing the transmission of infections, as well as best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic-resistant organisms.”
CMS Compliance will require:
- A hospital’s infection prevention and control and antibiotic stewardship programs be active and hospital-wide for the surveillance, prevention, and control of [hospital acquired infections] and other infectious diseases.
- Optimization of antibiotic use through stewardship.
Clinical and Laboratory Standards Institute (CLSI®)
Wilson, ML. Principles and Procedures for Blood Cultures, 2nd Edition.
CLSI Document M47Ed2E (ISBN Number: 978-1-68440-149-9) 2022
Infusion Nursing Society
Infusion Therapy Standards of Practice, 9th Edition
Nickel B, Gorski L; Kleidon T, et al. Journal of Infusion Nursing. 47(1S):S1-S285, January/February 2024.
Section 41. Blood Sampling. Practice Recommendations. Section I, Comment G, Part C, recommends: Consider the costs and benefits in implementing a consistent process to divert and discard the initial blood sample when drawing blood cultures. Studies have demonstrated reduction in blood culture contamination with use of a diversion device.”
Infectious Diseases Society of America (IDSA)
Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).
BLOODSTREAM INFECTIONS AND INFECTIONS OF THE CARDIOVASCULAR SYSTEM (pg 6)
To minimize the risk of contamination of the blood culture with commensal skin microbiota, meticulous care should be taken in skin preparation prior to venipuncture. In addition, products are available that allow diversion and discard of the first few milliliters of blood that are most likely to contain skin contaminant.
American Society for Microbiology
Amy L. Leber. 2016. Blood Cultures, p 151-182. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.4
Emergency Nurses Association (ENA)
ENA Emergency Nursing Resources Development Committee. Clinical practice guideline: prevention of blood culture contamination. Emergency Nurses Association; 2012 Dec.
Recommendation 13. Divert the initial 1–2 ml of blood into a sterile receptacle when drawing blood culture specimens via peripheral venipuncture. Level B – Moderate (Patton & Schmitt, 2010) (Note: New evidence is pending. When it is available, this recommendation will be updated if indicated.)
College of American Pathologists (CAP)
CAP 2018 Q-Tracks: MIC.22630
“It is recommended that blood culture statistics, including number of contaminated cultures, be maintained and reviewed regularly by the laboratory director. The laboratory should establish a threshold for an acceptable rate of contamination. Tracking the contamination rate and providing feedback to phlebotomists or other persons drawing cultures has been shown to reduce contamination rates.”
ML-019 Rev G