Effect of Kurin on Blood Culture Contamination Rates and Cost Savings

Background

Blood cultures are susceptible to contamination with skin commensal organisms. Contaminated blood cultures cost hospitals $4,000 to $10,000 per patient and extend hospital stay by 1 to 8.4 days. Initial specimen diversion devices (ISDDs) function by diverting a small volume of initial blood into culture bottles. Our study assesses blood culture contamination rates and associated cost savings of multiple Catholic Health Initiatives (CHI) sites using Kurin^®, which diverts 0.15 mL of initial blood drawn, compared to the standard blood collection method, which uses a butterfly needle and chlorhexidine without any blood diversion.

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Design

We performed a retrospective study between October 2022 and September 2023 across Creighton University Medical Center, Lakeside, Immanuel, Midlands, and Mercy Council Bluffs Hospital. Contamination rates were stratified by Kurin use and presented as percent alongside an Agresti-Coull confidence interval. Contamination rates were compared between Kurin and standard method sets both overall across all facilities and within each individual facility using the log binomial regression model. All analyses were conducted using SAS v. 9.4 with two-tailed p < .05 used for statistical significance. The cost savings and reduction in contamination rates after Kurin implementation were calculated. The cost of supplies was $17.50 compared to its standard method counterparts of $1.95. We estimated the cost of contaminated blood culture per patient as $4,538 (from a 2022 study by Marcelino et al.).

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Results

There was a total of 13,801 blood draws from the standard method and 15,011 blood draws from Kurin. Kurin averaged 47% lower risk of contamination compared to the standard method (95%, CI: 38.8-54.0%, p < 0.001). The average blood culture contamination reduction rate was 1.9% for the sites that showed statistically significant reduction (see Table). When projected over 12 months, the estimated total cost savings was $1,063,967.

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Conclusions

This study is the first to evaluate blood culture contamination rates before and after Kurin use across multiple departments while previous studies studied only the emergency department. A 2023 review paper by Mohajer and Lasco found that four of nine studies found reduction in contamination rate to less than or equal to 1% after Kurin implementation. Future studies could stratify contamination rates between staff such as nurses and phlebotomists and departments such as the emergency department and intensive care unit.