< 1% Blood Culture Contamination Rate

ABSTRACT

In the United States, approximately one-third of all positive blood cultures are falsely positive due to skin micro contaminations that are not eradicated by antiseptics during collection. A false positive blood culture can lead to unnecessary antibiotic therapy, additional laboratory testing, and excess healthcare costs including increased length of stay. Unnecessary antibiotic therapy increases the risk of allergic reactions, drug interactions, and drug-resistant superbugs. Extended hospital stays increase the risk of hospital-acquired infections and adverse events. The cost of a false-positive blood culture is estimated at $4,500-$10,000.¹

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BACKGROUND

The phlebotomy team used a diversion technique device, Kurin Lock®. The device is designed to collect the initial 0.15 mL of blood during venipuncture into a side chamber. Once the side chamber is filled, the sample bypasses the initial aliquot of blood and flows into the blood culture bottle. Prior to venipuncture, the skin is disinfected with 2% chlorhexidine gluconate/70% isopropyl alcohol (ChloraPrep®) for 30 seconds and allowed to dry. Direct venipuncture is performed using either a 21 or 23 gauge safety slide. After 0.15 mL of blood fills the Kurin Lock®, the prepped aerobic, anaerobic, or pediatric BD blood culture bottle is attached until the appropriate volume is collected. Prior to implementation the team had formal device training. The Lab Director and Phlebotomy Supervisors rounded with the team at ongoing intervals. Compliance and contamination data was captured by the Lab Quality Program Manager and emailed daily to the Laboratory Director and Supervisors. The team held recognition ceremonies to celebrate successful compliance and improved rates. Supervisors and Laboratory Director coached non-compliant users of the device.

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METHOD

ED pre-implementation: 464 contaminated blood cultures drawn out of 19,017 blood culture collected by phlebotomy and nursing in a 12-month period, for a contamination rate of 2.44%. ED post-implementation: 44 contaminated cultures out of 4577 blood culture collections drawn by phlebotomy in a 3-month period, for a contamination rate of 0.96%. Compliance rates rose from 63% during the first month of use to 98% the 3rd month. Consistent use of the Kurin Lock® was associated with a greater than 43% reduction in the ED blood culture contamination rate drawn by phlebotomists. SJHMC has estimates a savings of $280,000 per year based on $4,500 cost per contaminate model and the cost of the device.

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RESULTS

ED pre-implementation: 464 contaminated blood cultures drawn out of 19,017 blood culture collected by phlebotomy and nursing in a 12-month period, for a contamination rate of 2.44%.

ED post-implementation: 44 contaminated cultures out of 4577 blood culture collections drawn by phlebotomy in a 3-month period, for a contamination rate of 0.96%.

Compliance rates rose from 63% during the first month of use to 98% the 3rd month.

Consistent use of the Kurin Lock® was associated with a greater than 43% reduction in the ED blood culture contamination rate drawn by phlebotomists.

SJHMC has estimates a savings of $280,000 per year based on $4,500 cost per contaminate model and the cost of the device.

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CONCLUSIONS

The successful goal of < 1% blood culture contamination rate was achieved by utilizing the following:

Kurin Lock®, a diversion technique device

Appropriate disinfectant

Sterile techniques

Strong implementation plan

Successful change management process

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REFERENCES

1. Updated review of blood culture contamination. K.K. Hall, J.A. Lyman. Clin Microbiol Rev,2006; 19:788–802.

2. Economic health care costs of blood culture contamination: a systemic review. C. Dempsey, E. Skoglund, K. Muldrew., K Garey. American Journal of Infection Control; 2018.

3. CLSI. Principles and Procedures for Blood Cultures; Approved Guideline. CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.

4. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. H. Lee. JAMA 1991; 265:365–369.

5. Impact of Blood Cultures Drawn by Phlebotomy on Contamination Rates and Health Care Costs in a Hospital Bates, D. W., L. Goldman, and T. Emergency Department. Rita M. Gander, Linda Byrd, Michael DeCrescenzo, Shaina Hirany, Michelle Bowen and Judy Baughman. J. Clin. Microbiol. April 2009 vol. 47 no. 4 1021-1024.

6. Kurin.com/studies