CMS and Clinical Guidelines

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:

  1. 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.
  2. Optimization of antibiotic use through stewardship.

Read the Final Rule

Clinical Guidelines

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.”

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

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

CDC Clinician Guide for Collecting Cultures.
E. Septimus. Clinician Guide for Collecting Cultures 2015

ML-019 Rev C