Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings

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Hall RT, Domenico HJ, Self WH, Hain PD.
Pediatrics. 2013 Jan;131(1):e292-7.
Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee

  • Introduced a standardized sterile collection process to reduce peripheral blood culture contamination rate and unnecessary use of resources.
  • The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period.
  • There was a yearly estimated savings of ~$250,000 in hospital charges.

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Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates

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Bell M, Bogar C, Plante J, Rasmussen K, Winters S.
J Emerg Nurs. 2018 Apr 20. pii: S0099-1767(17)30148-4.
Lee Health Fort Meyers, FL; Cape Coral, FL.

  • Study data was limited to only those blood cultures collected with the device. It does not reflect the impact on the overall blood culture contamination rate.
  • The data showed an 82.8% reduction in false positives.
  • Based on the historical 3.52% rate of blood-culture contamination for the health facilities, 2.92 false positives were prevented for every 100 blood cultures drawn.

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Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device

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Rupp ME, Cavalieri RJ, Marolf C, Lyden E.
Clin Infect Dis. 2017 Jul 15;65(2):201-205.
University of Nebraska Medical Center, Omaha, NE

  • Study data was limited to only those blood cultures collected with the device. It does not reflect the impact on the overall blood culture contamination rate.
  • False positives increase laboratory costs by approximately 20%, are associated with a nearly 40% increase in antibiotic charges and can extend the length of hospital stay by up to 5 days.
  • False positive blood culture rate decreased from 1.78% to 0.22% with use of an Initial Specimen Diversion Device (ISDD).

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Innovation for Reducing Blood Culture Contamination: Initial Specimen Diversion Technique

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Patton RG, Schmitt T.
J Clin Microbiol. 2010 Dec;48(12):4501-3.
Northwest Hospital and Medical, Seattle, WA.

  • >0.5ml and <2ml is adequate diversion to significantly reduce contamination.
  • Initial specimen diversion technology reduced contamination of blood cultures by excluding contaminants from the first portion of the venipuncture-obtained culture specimen.

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Eliminating Blood Culture False Positives: Harnessing the Power of Nursing Shared Governance

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Moeller D.
J Emerg Nurs. 2017 Mar;43(2):126-132.
Advocate Health, Illinois

  • A new process decreased the blood culture contamination rate from a baseline rate of 5.37% to 1.76%.
  • The chief recommendation is to engage staff through clinical leadership.

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Reducing Blood Culture Contaminations in the Emergency Department: It Takes a Team

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Bowen CM, Coleman T, Cunningham D.
J Emerg Nurs. 2016 Jul;42(4):306-11.
Kennedy Health, Cherry Hill, NJ.

  • The plan targeted environmental and skin contaminates, teamwork, education, and feedback.
  • During the 8-week pilot, the monthly contamination rates were 1.96% and 0.3%, respectively. Subsequent data over 1 year revealed the contamination rates ranged from 0.2% to 1.51%, with a mean of 0.87%.

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Using lean management to reduce blood culture contamination

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Sinnott PL, Breckenridge JS, Helgerson P, Asch S.
Jt Comm J Qual Patient Saf. 2015 Jan;41(1):26-2.
Palo Alto Health Care System, Menlo Park, California, USA

  • Reduce the blood culture contamination rate using Lean management quality improvement methods, including a rapid process improvement workshop to identify root causes of variation in blood culture procedures and countermeasures (potential improvement strategies) to address each problem.
  • The blood culture contamination rate decreased significantly from 4.2% in the 19-month baseline period to 2.8% in the last 12 months of follow-up.
  • An estimated 261 contaminated blood culture were avoided in the follow-up period.

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Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams

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Self WH, Talbot TR, Paul BR, Collins SP, Ward MJ.
Infect Control Hosp Epidemiol. 2014 Aug;35(8):1021-8.
Vanderbilt University School of Medicine, Nashville, TN

  • Compared hospital costs associated with three collection strategies: usual care, sterile kits, and phlebotomy teams.
  • Baseline contamination rates associated with usual care, sterile kits, and phlebotomy teams were 4.34%, 1.68%, and 1.10%, respectively.
  • Compared to usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively.

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Reducing blood culture contamination in community hospital emergency departments: a multicenter evaluation of a quality improvement intervention

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Self WH, Mickanin J, Grijalva CG, Grant FH, Henderson MC, Corley G, Blaschke Ii DG, McNaughton CD, Barrett TW, Talbot TR, Paul BR.
Acad Emerg Med. 2014 Mar;21(3):274-82.
Vanderbilt University School of Medicine, Nashville, TN.

  • Measured the effect of implementing a sterile blood culture collection process.
  • At Hospital A, during the baseline period, 165 of 3,417 (4.83%) cultures were contaminated as compared to 142 of 5,238 (2.71%) during the intervention period. At Hospital B, during the baseline, 63 of 2,509 (2.51%) cultures were contaminated. But with the full sterile process, 51 of 1,865 (2.73%) cultures were contaminated.
  • Hospital B experienced poor adherence. So, a simplified sterile process used during intervention period 2 was associated with a significant reduction in contamination, with 17 of 1,860 (0.91%) cultures contaminated.
  • Monitoring the implementation process was important to identify and overcome operational challenges.

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Reducing false-positive peripheral blood cultures in a pediatric emergency department

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Marini MA, Truog AW.
J Emerg Nurs. 2013 Sep;39(5):440-6.
Children’s Hospital Boston, Boston, MA, USA.

  • Reduced the rate of false-positive peripheral blood cultures using blood culture kits, a dedicated team obtaining peripheral blood cultures, and following up with staff who draw a contaminated peripheral blood cultures.
  • The rate of false-positive peripheral blood cultures decreased from the baseline rate of 2.1%. to 1.4%.

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