The Impact of Blood Culture Diversion Devices on Contamination Rates

Monica E. Arenas, Janell Lukey, Grace Boseman, Dhammika Navarathna
Central Texas Veterans Health Care System, Temple, TX

Introduction
False positive blood cultures (BC) are associated with unnecessary hospitalization and/or extended length of stay with consequent financial burden. Our historical data shows that the majority of the false positive blood cultures are from the Emergency Department (ED). After repeated attempts of training, blood culture contaminations persisted at an unacceptable rate. Therefore, we recently [trialed] two different types of FDA 510(k)-approved devices* designed to eliminate blood culture contamination by sequestering the initial few drops of blood (first draw) which is considered to carry contaminant flora. It has been shown [that] the bacteria which colonize the human skin are not only on the surface but deeper in the skin as well. The Steripath and Kurin devices divert the initial small volume of blood as to remove any potential skin plug [which] contains contaminants.

Steripath® Blood Culture Collection System

  • This is a single use sterile blood culture collection system.
  • SteriPath® is designed for initial blood specimen diversion using a preassembled vein-to-bottle closed system that mechanically diverts and sequesters the initial 1.5 to 2 mL of blood into a proprietary isolation chamber.

Kurin® Blood Culture Collection System

  • This device is a sterile, single use blood culture collection set. The Kurin® device consists of a winged needle with flexible tubing and an attached vial adapter required for venipuncture to draw blood culture samples.
  • The Kurin blood capture device sequesters the initial draw of blood upon venipuncture. The set is provided with a safety shield for covering the used needle prior to disposal.
  • The amount of blood diverted is very small, estimated to be 0.2-0.1 mL.





*Correction: as of June 2019, the Steripath device had not received 510(k) clearance.

Conclusion

  • Appropriate aseptic technique and the use of Steripath® or Kurin ® devices made a remarkable decrease in contamination [in the] ED.
  • Reduced false positive cultures and eliminated additional resources for workup are cost beneficial.
  • Avoid unnecessary antibiotic treatment and hospitalization days.
  • Initial specimen diversion volumen variation from 0.2ml–2ml did not have a significant impact on contamination rate.

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References:
Magnolia Medical Technologies. (2015) The SteriPath System. magnolia-medical.com/steripath/

Kurin, manufactured in San Diego, CA has received FDA 510(k) market clearance.

Innovation for reducing blood culture contamination: Initial Specimen diversion technique. Patton RG, Schmitt T. J Clin Microbiol. 2010 Dec;48(12):4501-3. 

Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Self WH, Speroff T, Grijalva CG, McNaughton CD, Ashburn J, Liu D, Arbogast PG, Russ S, Storrow AB, Talbot TR. Acad Emerg Med. 2013 Jan;20(1):89-97.