QAPI 114 - Reducing Blood Culture Contamination Rates Through a Quality Improvement Initiative Targeted Toward Non-laboratory Staff.

Background

A blood culture contamination (BCC) event is defined as a blood culture set that is positive for a commensal organism that is not present in the blood sample. These events can have a cascading number of negative outcomes that include unnecessary antibiotic exposure, return visits, prolonged hospitalization, and avoidable substantial costs. BCC events are traditionally thought of as a laboratory metric, however laboratory staff do not exclusively collect the samples. Our objective was to review historical BCC data collected by non-laboratory staff and develop and implement an action plan.

Methods

This quality improvement project was implemented in January 2023 in the emergency departments (ED), which included a free-standing ED and a main campus ED, and two critical care (CC) units in a pediatric hospital. BCC review tool (BCCRT) was developed to evaluate the following: proper blood culture collection practices, necessary supplies and diversion devices available and utilized, and review of other potential contributing factors. Beginning February 2023, all BCC events occurring in the ED and CC units were reviewed with unit leaders and staff collecting the BCC event and the BCCRT was completed. BCC rates were compared using a student t-test.

Results

Comparing 2022 to 2023, the overall BCC rate had a 45% reduction. Similarly, the ED and CC areas had 45% and 41% reductions, respectively, for the same timeframe. The overall BCC, ED BCC, and CC BCC rates (2.08%, 2.64%, and 2.54%, respectively) were significantly lower in 2023 compared to 2022 (3.80%, 4.85%, and 4.31%, respectively).

Conclusions

The implementation of a BCC review process in the ED and CC units resulted in a significant decrease in BCC rates between 2022 and 2023. This improvement demonstrates the effectiveness of a BCC quality improvement initiative targeted towards non-laboratory staff and has the potential for broader application among other clinical areas.