This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. blood culture contamination in the emergency department: Sterile collection kits and phlebotomy teams. Blood cultures are commonly ordered in the emergency department (ED) setting to evaluate for bacteremia. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. Introduction: The blood culture (BC) contamination was a significant problem in our hospital, especially in the emergency department (ED). OBJECTIVES: Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. All PDSA cycle data on the project measures were extracted from the lab information system to be analyzed and presented on run and control charts. All 13 studies reported sustained contamination rates of 1% or below when Steripath was used in the emergency department, . Both RNs and EDTs were also required to participate in an annual refresher program for proper BC collection. (2006). Gannon M. Practical steps to lower blood culture contamination rates in the emergency department. 10 Hall, K. K., & Lyman, J. 1, Hospital A). Purpose collection system in reducing blood culture contamination rates. Methodology/Principal Findings A prospectively observational study in a university-affiliated hospital were conducted between August . Quality Initiative: Reducing Blood Culture Bottle Contamination Rates Simple strategies can improve quality outcomes Mark Book, BS, RN, CEN, Staff Development Instructor Harrisburg Emergency Department, PinnacleHealth System Quality Related Issues: • Blood culture contamination rates were found to be consistently elevated (5 - 6%) on blood conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. This study describes 2 years of quality improvement (QI) interventions that aimed to decrease a high BCCR in a pediatric ED. Reducing the Rate of Blood Culture Contamination in the Emergency Department of a University Teaching Hospital. The secondary aim was to decrease the peripheral blood culture ordering rate (BCOR) by 10% within 24 months. Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. Reducing false-positive peripheral blood cultures in a pediatric emergency department. Typical interventions to reduce blood culture contamination, such as ongoing training and education on best practices, cannot address the skin and skin plug contamination and have shown only modest and . 1 Given the negative impact this could have on patient outcomes, a quality improvement project was developed in order to ensure delivery of the highest quality of care. 1, Hospital A). Based on the . Blood culture collection remains the gold standard to diagnose bacteraemia. Conclusions The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. Contaminant blood cultures and resource utilization. The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. BACKGROUND AND OBJECTIVE:. Contaminated blood cultures add an exorbitant financial . We hypothesized that initial blood specimen diversion without a designated device or procedure would suffice for reduction in blood culture . From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. Pediatrics, 131(1), e292-e297. In 2014, the National Hospital Ambulatory Medical Care Survey estimated that ED clinicians had obtained over 840,000 blood cultures on children in EDs in the United States. The ED BC contamination rate spike . Go to: Baseline measurement (2018). The blood culture is an essential tool for diagnosing bloodstream infections and guiding antibiotic therapy. Blood culture contamination in emergency departments (ED) that experience a high volume of patients has negative impacts on optimal patient care. Blood cultures in the emergency department (ED) are frequently overused and their use does not follow recommendations and guidelines. Methods Conclusions: The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. A financial measure estimated the savings in charges between the observed and expected contaminants in PDSA3. Same-site collection rates decreased from 15.13% to 4.14%. To promote proper technique related to blood culture specimen collection in an effort to reduce contamination, educational interventions have been examined. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. Blood cultures are commonly performed in the emergency department (ED) due to the important diagnostic and prognostic information they can provide to clinicians. Local problem: Blood culture contamination rates trailed the national threshold of less than 3% in one southeastern US emergency department (ED). Bates DW, Goldman L, Lee TH. the aim of reducing the blood culture contamination rate in our ED to less than 3% and sustaining this low rate. 2013;131(1):e292-7. 10 Hall, K. K., & Lyman, J. Objectives Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. 2-8 Patients . Methods: The QI team created a Key Driver Diagram with multiple Plan-Do-Study-Act (PDSA) cycles. They found that after the diversion protocol was introduced, the contamination rate in the emergency department dropped from 2.92 percent to 1.95 percent, while the inpatient contamination rate dropped from 1.82 percent to 1.31 percent. Journal of Emergency Nursing, 44(6): 570-575. the . 26 27 Faced with these contamination rates clinicians cannot be sufficiently confident in initial positive BC results to alter patient management. 1 Unfortunately, blood culture contamination is common, leading to increased morbidity and overall cost burden. Hall RT, Domenico HJ, Self WH, Hain PD. This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. Modification of Blood Test Draw Order to Reduce Blood Culture Contamination.Clin Infect Dis. Current literature The use of the diversion device reduced the rate of blood culture contamination from 1.78% to 0.22%, without reducing the sensitivity for detection of true bacteremia and candidemia. The College of American Pathologist set a national benchmark for blood culture contamination rate at 3%. (Fig. Hence, it is imperative that the rate of contamination is minimized in order for blood culture testing to be considered cost-effective. Blood-culture results may affect clinical decision making. The study objective was to develop and . A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure, which led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate. In 2015, Houston Methodist Willowbrook Emergency Department blood culture contamination rate was 6.23% due to lack of training and inconsistent technique. For ED and inpatient cultures combined, the rate dropped from 2.46 percent to 1.70 percent. The study, therefore, was undertaken to improve the BC collection in the ED. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. 1, Issue. Blood culture contamination carries risks for patients, such as unnecessary antimicrobial therapy and other additional hazards and costs. Blood culture contamination rates decreased from 3.39% to 2.6%. In the past, a blood culture contamination rate of less than 3% was deemed acceptable. All 13 studies reported sustained contamination rates of 1% or below when Steripath was used in the emergency department, . Marini, M. (2013, September). The total blood culture contamination rate in January-March 2019 decreased to 3.1%. Both EDs A and B showed decreases in their contamination rates to 5.5% and 7.4%, respectively, in 2018-2019. Journal of Emergency Nursing, 39(5), 440-456. Why Do We Care? From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. Conclusions: Venipuncture and the use of phlebotomy teams are effective practices for reducing blood cul- ture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. Methods: The study was conducted for 1 year divided into two phases of 6 months each: Preintervention phase and intervention phase (regular and phlebotomist groups). J . Ropp, P. (2012, February). PMID: 22727270. . Results: Over a 6-month period, a reduction in the BCC rate at the emergency department (ED) of the University Hospital reached 1.5% compared with the baseline at 4.0%. In total, 8,525 blood culture sets were received in January-March 2019; of these, the EDs contributed 2,799 sets (32.8%). Both RNs and EDTs were also required to participate in an annual refresher program for proper BC collection. • Rates of blood culture contamination can be as high as 6%2. Objectives: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. Fig. Magnolia Medical Technologies, Inc., inventors of Steripath®, the only FDA 510(k)-cleared device platform specifically indicated to reduce blood culture contamination for sepsis testing accuracy . 1 however, false positive blood cultures due to specimen contamination with skin bacteria are a common problem that leads to unnecessary patient morbidity, increased hospital costs, and health care system inefficiencies. OBJECTIVES Blood culture contamination is a common problem in the emergency department . J . Developing a plan that is evidence-based and feasible in the fast paced Emergency Department can . Steps to lowering blood culture contamination rates in the ED. Global Journal on Quality and Safety in Healthcare, Vol. Yes, according to literature, 20% to 50% are likely false positives.¹ Blood culture contamination rates should not exceed the recommended 3% of all blood culture collections according to the American Society for Microbiology (ASM) and the Clinical Laboratory Standards Institute (CLSI).¹. Several suggestions have been proposed for ways to reduce blood culture contamination rates. Interventions Interventions to reduce blood culture contamination, including prep kits . Discussion The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. The median contamination rate by clinical assessment (2.1%) was significantly lower (P = .005), primarily because of a lower proportion of cultures with coagulase-negative Staphylococcus that were interpreted as contaminants when only one of multiple specimens was positive. Updated review of blood culture contamination. This can delay early targeted treatment and be detrimental to patient care. This can delay early targeted treatment and be detrimental to patient care. Methods that should be employed to decreased blood culture contamination include the following: Patient selection: Blood cultures should only be . Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates. 1, p. . Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Journal of Emergency Nursing, 39(5), 459-464. 3% blood culture contamination rate in an Emergency Department Cultures / month: Contamination Rate: Patients impacted by false positives / month: . Compared with 2008, BCC rates for the ED showed steady reduction from 5.52 to 1.42% in 2011 and leveled out consistently below 1.6%. Impact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of . 2013 Sep;39(5):459-64. doi: 10.1016/j.jen.2012.03.006. 1 However, false positive blood cultures due to specimen contamination with skin bacteria are common and lead to patient morbidity and escalation of healthcare costs. . Wednesday, February 5, 2014. . Article Google Scholar Harding AD, Bollinger S. Reducing blood culture contamination rates in the emergency department. (2006). It is therefore important to identify risk factors associated with blood culture contamination in EDs. Same-site and single-set collection issues were . Methods: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. INTRODUCTION. Conclusions: The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. •Blood culture contamination rates in the emergency department regularly exceed the national standard of less than 3%. The commitment from our team was considered the most valuable asset and strategy. We hypothesized that the introduction of a standardized . Same-site collection rates decreased from 15.13% to 4.14%. Perhaps the most striking result is that 97% of positive cultures represented true positives with the diversion device, compared to 81% without the diversion device. EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination . Purpose: Updated review of blood culture contamination. cost of $1.4 to $1.8 million. 1, p. Global Journal on Quality and Safety in Healthcare, Vol. Reducing our contamination rates would directly coincide with the system and GCMC's lean strategic planning goals of reducing infections and length of stays. T.R., Paul, B.R., Collins, S.P . 17 Manual diversion of the initial volume of blood • Peer-reviewed published data has shown only modest unsustainable reductions in contamination • Lowest published contamination rate achieved is 2.0%1 (best case controlled clinical study scenario) 1Zimmerman, et al. Fig. Current evidence suggests that the emergency department (ED) often has blood culture contamination (BCC) rates above the recommended 3%, contributing to increased hospital length of stay, unnecessary or inappropriate antimicrobial treatment, and increased economic burden. 26 27 Faced with these contamination rates clinicians cannot be sufficiently confident in initial positive BC results to alter patient management. Reducing the Rate of Blood Culture Contamination in the Emergency Department of a University Teaching Hospital. EDs' positive BC rates have been shown to range from 3.4%-7.9% with contamination rates 0.6-7.9%. DISCUSSION: The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. . collection system in reducing blood culture contamination rates. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. the blood culture is an essential tool for diagnosing bloodstream infections and guiding antibiotic therapy. 1 Infect . August 25, 2021. With Magnolia Medical's Steripath® Gen2 Initial Specimen Diversion Device® (ISDD®), hospitals now have an extra layer of contamination protection. Blood culture collection remains the gold standard to diagnose bacteraemia. The task force included an emergency physician cham- pion, an ED nurse champion, the chief hospital epidemi- ologist, ED administrators, ED nursing leadership, microbiology laboratory personnel, and infection control personnel. A Quality Improvement team was created to try to reduce contamination rates to the recommended target. The November data of the blood culture contamination rate in the emergency department and the national average are two distinct data that are available at this stage of the paradigm. EDs' positive BC rates have been shown to range from 3.4%-7.9% with contamination rates 0.6-7.9%. Using Shared Governance to Reduce Blood Culture Contamination Rates in the Emergency Department. 1, Issue. Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. Steripath, the only FDA 510 (k)-cleared device indicated to reduce blood culture contamination, is engineered to deliver sustained contamination rates of under 1.0% in the emergency department . Objectives Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. Pediatrics. 2019; 2Data on file;; 3Tompkins . A. This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. Clinical Microbiology Reviews, 19(4), 788-802. Baseline measurement The blood culture is an essential tool in clinical medicine for detecting bacteremia and guiding antibiotic therapy.