Automatic Diversion Outperforms Waste Tubes: BCC rates with Kurin decreased 80%

How closed-system automatic diversion devices outperform manual open waste tube techniques in clinical practice.

The aim of blood culture diversion is to sideline initial blood away from the collection vessel to reduce the chances that blood contaminated with skin flora is sent to the laboratory for culture.^1,2,3 The principle is similar to the collection of a midstream urine sample, where the initial flow of urine, which is most likely to be contaminated, is discarded.

Hospitals often trial waste tube diversion citing the availability of standard, inexpensive vacuum tubes already in stock. However, the challenges of manual waste tubes are numerous.⁴ Clinicians must disinfect the tube top, insert the tube into the specimen bottle holder, wait for it to fill, remove it, and then insert the blood culture bottle. In busy hospital environments, nurses may suffer from discipline fatigue. The process also introduces extra physical touchpoints which increase the risk of specimen contamination.

In a study at Crouse Hospital, Allain⁵ illustrated how automatic diversion outperforms waste tubes. After trialing waste tubes with ongoing staff education, the facility transitioned to automatic diversion (Kurin Lock) citing greater efficiency for phlebotomists. With Kurin, Crouse reduced their contamination rate to 0.8%. Likewise, Biddle and Whitis⁶ compared BCC reduction strategies across two emergency departments at a Level I trauma center utilizing a passive diversion device and a community hospital utilizing waste tubes. The trauma center achieved an almost 2x greater reduction in BCC (33% vs 18%), indicating that the automatic diversion device outperformed waste tubes despite a more complex, high-acuity environment. The estimated ROI of the automatic device was almost 3x that of the waste tubes, despite a higher upfront investment cost.