Impact on Emergency Department Blood Culture Contamination

Jeannie Burnie, MS, APRN, AGCNS-BC, CEN, FAEN, FCNS and Samantha Vining, MSN, RN, FNP-C
TriHealth and Bethesda North Hospital, Cincinnati, Ohio.

Clinicians at TriHealth Bethesda North Hospital published new clinical findings related to blood culture collection, a common procedure performed in emergency departments. Rate of blood culture contamination is a metric that is tracked by organizations to ensure appropriate treatment for patients suspected of having bacteremia and ensure appropriate use of hospital resources. The co-authors, Jeannie Burnie and Samantha Vining noted that, “The College of American Pathologist guideline recommends blood culture contamination (BCC) rates of less than 3%.” However, their suburban ED located in a midwestern city was not consistently meeting this recommendation. Therefore, a team of nurses and technicians undertook a quality improvement project to decrease blood culture contamination rates in a suburban emergency department.

According to the authors, the project included use of standardized blood culture collection kits, creation of a dedicated collection team, and implementation of a new blood culture collection device (Kurin, Inc., San Diego, California) “designed to sideline potential skin contaminants with a passive, low-volume (0.15 mL) initial specimen discard.” In order to cost justify the new device, the ED clinical nurse specialist worked with the organization’s value analysis coordinator to determine the associated costs to the organization per BCC incident revealing “an increased length of stay of 2.65 days and an increase in cost of admission of $5863 per BCC.”

TriHealth’s results showed immediate, significant and sustained improvement. According to the authors, “In 2018, the average BCC rate was 2.92%. In 2019, after the implementation of the Kurin diversion device intervention, the average BCC rate dropped to 1.42%, a 51% decrease.” The team continued to monitor BCC rates and estimated cost savings of “nearly 2 million dollars.” The authors noted that during the study, “nearly 250 patients have benefited from the introduction of the Kurin diversion device.” Blood culture contamination rates remained below 1.5% consistently for a 2-year period.

Upon achieving these results, the improvement project was initiated in a second TriHealth ED. Evaluation data from the first 6 months of Kurin use at the second ED “have been impressive and have shown marked improvement in BCC rates, from a pre-implementation rate of 4.96% to a postintervention rate of 1.6%,” representing a decrease of over 70%.

The TriHealth team employed a variety of change processes yet the authors specify that “the use of the Kurin device and focused individual feedback have been the key to sustaining BCC rates consistently lower than the accepted contamination rates.”