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.”
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.
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.)
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
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
ML-019 Rev E