Children’s Hospital Achieves Zero Contaminations with Kurin Lock

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Oishei Children’s Hospital, Buffalo, NY.

Key Takeaways

  • This was the first published clinical study in a pediatric hospital demonstrating the impact of Kurin’s PIV product.
  • During the two phases of the trial, the ED staff collected almost 1200 cultures with ZERO contaminations when using Kurin. The overall rate during the trial was ~0.5%. (0% with, 8.4% without).
  • Clinical results showed ~80% decrease overall in the BCC rate compared to their historical average.

The Situation

Oishei Children’s wanted to reduce blood culture contaminations (BCC) and improve on historical rates that were closer to 3%. With Kurin, they collected almost 1200 cultures without a single contamination. This data was presented at APIC in 2021.

Baseline & Interventions

As in most facilities, false positive blood cultures (FPBCs) were an ongoing problem. Rates were generally near 3% but occasionally reached 5% or more. Blood cultures were obtained by trained RNs. Leadership provided additional education to nurses who drew FPBCs but 1:1 education yielded only temporary results.

Kurin Implementation & Process

Kurin was used in the first phase of the trial during the summer of 2018. After comparing data to historical averages, a second trial period was completed during the summer of 2019 with similar results. Hospital policy was to collect cultures from a freshly placed IV, so Kurin’s low-volume PIV was the appropriate product to accommodate this policy.

Summary

Rates dropped ~80%, down to ~0.5% during the Kurin trial periods. When measuring rates when Kurin was used, the children’s hospital reported a 0.0% rate. The authors reported this result as clinically significant with a p-value of 0.00001.

Download a PDF of this study.

Anticipating new CMS metrics, AZ Hospital finds BCC Solution

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Valleywise Health Medical Center

Key Takeaways

  • The health system was committed to improving their blood culture contamination (BCC) rate for quality purposes and in response to recent activity by CMS regarding the need to reduce BCC.
  • An attempt to reduce BCC with Steripath showed improvement, but it was short-lived as nurses rejected the product as an option.
  • The introduction of Kurin Jet reduced BCC by 72% and the lower rates have been sustained.

The Situation

Blood culture contamination (BCC) was a problem, especially in busy EDs. Historically, rates were usually above the outdated 3% benchmark, sometimes significantly. With CMS intending to establish BCC as a quality metric that may eventually carry financial penalties, the hospital committed to improvements in this area and has adopted the 1% benchmark recently put forth by CMS, the CDC, and other organizations. Implementing Kurin Jet resulted in sustained low rates, down to ~1.5%, well on their way to this new goal.

Baseline & Interventions

BCC rates fluctuated over the past couple of years, but rarely met the historical 3% benchmark. Nursing and Quality were eager to improve their BCC rate as lower contaminations mean better patient care. Likewise, the Lab was concerned over workflow and repeat testing on false positive blood cultures. Valleywise originally brought in Steripath Gen 2 and, although they achieved results in one month, the nurses did not like the product and looked for an easier-to-use solution. With the introduction of Kurin Jet, rates dropped to ~1.5% and stayed there. Nurses were pleased with how easy Jet was to use and how quickly it worked.

Kurin Implementation

Valleywise made an important decision prior to trying new devices. Since a disproportionate number of contaminated cultures were caused by traveling nurses, the hospital focused on core staff being responsible for blood cultures. Removing traveling nurses from blood culture collection kept monthly rates closer to 3-4% and eliminated months with very high BCC rates of 6% or higher. With the core staff, Valleywise introduced Steripath 2 to help lower rates under 2%.

After the Steripath trial was stopped due to the nurses finding it unacceptable, Kurin Jet was introduced. Since Jet was so easy to use by comparison, the implementation was relatively simple. Training was provided and the nursing staff warmly welcomed this new, more user-friendly technology.

Summary

The hospital felt compelled to address their BCC problem as they could achieve immediate clinical and financial benefits. In addition, they saw the opportunity to improve this aspect of patient care before CMS proceeds to financial penalties for poor BCC performance. Kurin Jet fit seamlessly into nursing workflow and was determined to be easy enough to yield sustainable results. Valleywise followed the recent CDC guidance on the financial impact of the average BCC, which is ~$4,500 per contamination. Given their volume of cultures, their rate reduction meant that >30 patients each month avoided the complications of a BCC. At a cost of $4500 per BCC, the use of Jet will save the hospital over $1.5M per year. With the impending change to a 1% BCC target, this facility is now well positioned for future performance metrics.

Download a PDF of this study.

It takes more than Education!

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Suburban Emergency Department, Midwest

Key Takeaways

  • Education and blood culture collection kits set a baseline blood culture contamination (BCC) rate of just under 4% for a calendar year.
  • Education, a dedicated BC collection team, and accountability enabled the facility to average ~3% for the following year.
  • The introduction of Kurin Lock® significantly lowered the average BCC rate to 1.4% (a 63% decrease) for 2+ years.
  • Utilizing their own calculations, the hospital estimates cost avoidance savings from their combined efforts at ~$2 million over the two years.

The Situation

This case study highlights the multi-pronged efforts of a single Midwestern emergency department to reduce blood culture contamination (BCC). Over a four-year period, they emphasized education and accountability, but it wasn’t until they added Kurin technology to the mix that they met and sustained their goals.

Baseline Performance

With an unacceptable historical BCC rate, ED leadership established a 3% goal, focused on best practices and education, which resulted in a rate a little below 4% but was subject to wide fluctuations, as high as 5%. Adding a custom blood culture kit caused rates to increase, so these were abandoned. The facility moved to dedicated techs for collection, eliminating RN draws, and made BCCs an employee performance metric, which helped stabilize their rates at 3%.

Kurin Implementation and Process

In February 2019, the ED implemented the Kurin Lock and no additional changes were made. For two years, rates averaged less than 1.5%, with no single month higher than 2.2%. The fact that this significant rate decrease occurred during the COVID-19 pandemic is even more impressive.

Summary

Continuous education and accountability played important roles in this ED’s effort to address the clinical and financial problems caused by BCCs. However, these tactics alone did not deliver the optimal results, and it was only through the addition of Kurin technology that they were able to meet their goals. They worked with their finance department to determine the financial impact of these contaminations and found an average cost differential of about $5,800 per contamination. Given their volume of cultures, they estimate this single ED saved approximately $2 million over the two years. With the impending change to the 1% target, this facility is now better able to meet and sustain their goals.

Download a PDF of this study.

Kurin helps Hospital Go from Good to Great

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Integrated Hospital System, Southeastern, OH

Key Takeaways

  • Community Based Hospital had implemented blood culture collection best practices with a diversion technology and achieved <1% target (0.77%).
  • Leadership discovered Kurin at a national tradeshow. Facility leadership recognized improved design, no new clinical steps, less waste volume and cost savings over current technology.
  • After 9 months of Kurin, system has achieved an average overall contamination rate of 0.49% (36% reduction) and has saved an additional $125,000 in annual savings from reduction of contaminations and cost of technology.

The Situation

  • BCC reduction with Steripath was not sustained, impacted by challenges with compliance.
  • Kurin was trialed because it looked easier to use and it was less expensive.
  • BCCs were reduced a further 36%, driving their BCC rate to 0.49%.
  • Hospital saved an additional $125K in less than one year.

Baseline Performance

Phlebotomists collect blood cultures in this 205-bed flagship hospital of this health system. Their BCC rates were already well below the national average due to their emphasis on best practices, but the hospital wanted to reduce these contaminations further, so brought in the Steripath device. Although initial months did show some improvement, compliance lagged and rates increased. Laboratory leadership saw Kurin at the 2022 AACC and recognized an easier-to-use device that might improve compliance. Kurin was also less expensive, so they brought it in.

Kurin Implementation and Process

Exercising caution not to sacrifice quality with a lower cost item, a trial was initiated with just two phlebotomists and in that first month, the data illustrated the value in switching to Kurin. The users provided feedback that Kurin was exceptionally easy to use. With the full implementation, compliance indeed had improved, driving the overall rate down below 0.5%, a 36% reduction. Kurin drove down rates that were already good to make them great.

Results

Kurin’s ease-of-use helped this community hospital find greater success in reducing BCCs compared to their attempts with Steripath. Compliance has consistently exceeded over 80% per month and, based on the recent CDC estimate on the cost of a false positive blood culture and savings per device, the hospital has already saved an additional $125,000+.

Download a PDF of this study.

Strategy for Avoiding False-positive CLABSIs

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Academic Hospital, Southern U.S.

Overview
This case study summarizes how Kurin helped an Academic Hospital (AH)* eliminate their false positive CLABSIs. These false positives “meet definition” and thus must be submitted to the CDC’s National Healthcare Safety Network (NHSN). In addressing these contaminations, AH made progress with education and a best practices bundle, but only achieved their goal of eliminating false positive CLABSIs by using Kurin.

The Situation

  • Leadership motivated to decrease BCC to eliminate reporting false CLABSIs
  • Implemented best practice bundle
  • Kurin and Steripath participated in a head-to-head trial where Kurin prevailed.

Baseline Performance

An ICU had been averaging nine blood culture contaminations (BCC) per month and began a six-month long initiative implementing a best practices bundle that included the following:

  • Dedicated team to draw blood cultures
  • Increased focus on skin antisepsis – this includes bathing the arms in CHG prior to standard skin prep
  • Education and competency sign off
  • An escalation/checklist tool that is required for each blood draw

This initiative was successful and brought the contamination total down to ~4/month; the facility was further driven to eliminate these contaminations.

Kurin Implementation and Process

Expanding on best practices, the ICU incorporated Kurin into their blood culture bundle to assess its potential in eliminating contaminations and preventing false positive CLABSI cases.

The introduction of Kurin was the only changed variable during a 90-day efficacy trial, and during this period the ICU recorded ZERO contaminations with Kurin. The Steripath device was also shown to be effective in this regard, however the simplicity of Kurin made it the clinically preferred product.

Conclusion

The Kurin 90-day trial was a head-to-head comparison between Kurin and Steripath to reduce BCC rates.

  • After the evaluation, Kurin was selected because nurses found it much easier to use.
  • The successful implementation led to the adoption of Kurin in additional departments and hospitals throughout the system.

AH now considers Kurin a cornerstone of their CLASBI risk mitigation strategy to avoid reporting false positive CLABSIs, resulting in lower hospital costs and better patient care.

Download a PDF of this study.

NOTES:
* AH has asked to remain anonymous as they prepare this data for publication.

Kurin Helps Entire Health System Achieve 1%

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Four-Hospital Health System, Southern U.S.

Key Takeaways
A four-hospital health system in the southern US experienced a system-wide blood culture contamination (BCC) rate above 6.0% despite multiple interventions.

  • The implementation of Kurin ultimately resulted in system-wide savings greater than $12 million with sustained results well below national standards.
  • This case study highlights the steps this system took to finally achieve their goal of being below the 1% target.

Situation

  • Estimated $13.5M lost annually
  • Steripath ISDD reduced baseline 6.2% to 2.8%
  • Could not meet 1% target with Steripath product line
  • Introduced Kurin to increase compliance and system achieved 1% target

Baseline Performance

The system had a mean BCC rate of 6.2% across all four hospitals.

Pre-diversion interventions:

  • Education
  • Developed CLABSI Nurse Quality Team
  • Eliminated central line draws

The system implemented the Steripath® Initial Specimen Diversion Device (ISDD) trialing two products: Gen II and Micro.

  • Over 12 months, the Steripath ISDD lowered the system-wide BCC to an average of 2.85%.
  • The hospital attributed poor compliance to the device’s difficulty of use, and they were unable to achieve the 1% target for BCC recommended by CLSI and CDC1,2

To improve compliance and further reduce BCC, the system adopted Kurin passive technology as an alternative intervention.

Kurin Implementation and Process

The system’s commitment to a process improvement framework laid the foundation for the successful implementation of the Kurin Lock®.

  • In-person and online resources aided adoption
  • Kurin Lock was integrated into standard kits and tracked compliance through EMR
  • Kurin Lock seamlessly integrated into hospital procedures

The comprehensive, device driven, implementation led to an immediate reduction in BCC rates.

Results

The adoption of Kurin led to a significant decrease in the system-wide contamination rate, declining to <1%.

  • This reduction from baseline results represents an estimated annual savings of $12.2M based on the average CDC cost of contamination1.
  • Switching from Steripath (2.85%) to Kurin (<1%) represents an additional estimated savings of $4.9M annually for the system.

Download a PDF of this study.

REFERENCES:
1 CDC. Blood Culture Contamination: An Overview for Infection Control and Antibiotic Stewardship Programs Working with the Clinical Laboratory. August 2022.
2 CLSI. Principles and Procedures for Blood Cultures. 2nd ed. CLSI guideline M47. Clinical Laboratory Standards Institute; 2022.