Reduction of False Positive Central Line Associated Bloodstream Infections Using a Blood Culture Collection Algorithm

Abstract Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

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A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

Biomedicine Hub ◽

10.1159/000486703 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Linze F. Hamilton ◽

Helen E. Gillett ◽

Adam Smith-Collins ◽

Jonathan W. Davis

Keyword(s):

Intensive Care ◽

Blood Culture ◽

False Positive ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Group Versus ◽

Antibiotic Use ◽

Culture Collection ◽

Blood Cultures ◽

Before And After

Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

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Improvement in the Diagnosis of Patients With Central Line-Related Bloodstream Infections by Proper Blood Culture Drawing and Labeling in an Emergency Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.751 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Anne-Marie Chaftari ◽

Patrick Chaftari ◽

Javier Adachi ◽

Ray Hachem ◽

Sammy Raad ◽

...

Keyword(s):

Blood Culture ◽

Bloodstream Infections ◽

Central Line ◽

Emergency Center

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Electronic Surveillance for Healthcare-Associated Central Line—Associated Bloodstream Infections Outside the Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/662181 ◽

2011 ◽

Vol 32 (11) ◽

pp. 1086-1090 ◽

Cited By ~ 35

Author(s):

Keith F. Woeltje ◽

Kathleen M. McMullen ◽

Anne M. Butler ◽

Ashleigh J. Goris ◽

Joshua A. Doherty

Keyword(s):

Intensive Care ◽

Blood Culture ◽

Predictive Value ◽

Chart Review ◽

Positive Culture ◽

Bloodstream Infections ◽

Central Line ◽

Electronic Surveillance ◽

Predictive Values ◽

Best Fit

Background.Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patient-level variables and microbiology data was investigated.Methods.Patients with a positive blood culture in 4 non-ICU wards at Barnes-Jewish Hospital between July 1, 2005, and December 31, 2006, were evaluated. CLABSI determination for these patients was made via 2 sources; a manual chart review and an automated review from electronically available data. Agreement between these 2 sources was used to develop the best-fit electronic algorithm that used a set of rules to identify a CLABSI. Sensitivity, specificity, predictive values, and Pearson's correlation were calculated for the various rule sets, using manual chart review as the reference standard.Results.During the study period, 391 positive blood cultures from 331 patients were evaluated. Eighty-five (22%) of these were confirmed to be CLABSI by manual chart review. The best-fit model included presence of a catheter, blood culture positive for known pathogen or blood culture with a common skin contaminant confirmed by a second positive culture and the presence of fever, and no positive cultures with the same organism from another sterile site. The best-performing rule set had an overall sensitivity of 95.2%, specificity of 97.5%, positive predictive value of 90%, and negative predictive value of 99.2% compared with intensive manual surveillance.Conclusions.Although CLABSIs were slightly overpredicted by electronic surveillance compared with manual chart review, the method offers the possibility of performing acceptably good surveillance in areas where resources do not allow for traditional manual surveillance.

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81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.283 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S157-S157

Author(s):

Sujeet Govindan ◽

Luke Strnad

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Cost Savings ◽

Bloodstream Infections ◽

Central Line ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Candida Sp ◽

Daily Frequency ◽

Oregon Health

Abstract Background At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed. Methods Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures. Results 95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000. Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020 Conclusion Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution. Disclosures All Authors: No reported disclosures

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Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

Infection Control and Hospital Epidemiology ◽

10.1086/668431 ◽

2013 ◽

Vol 34 (1) ◽

pp. 89-92 ◽

Cited By ~ 27

Author(s):

Joshua T. Freeman ◽

Anna Elinder-Camburn ◽

Catherine McClymont ◽

Deverick J. Anderson ◽

Mary Bilkey ◽

...

Keyword(s):

Blood Culture ◽

Febrile Neutropenia ◽

Positive Predictive Value ◽

Bloodstream Infections ◽

Central Line ◽

Blood Cultures ◽

National Healthcare ◽

Culture Positivity ◽

National Healthcare Safety Network ◽

Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

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The Impact of COVID-19 Response on Central Line Associated Bloodstream Infections and Blood Culture Contamination Rates at a Tertiary Care Center in Greater Detroit Area

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1335 ◽

2020 ◽

pp. 1-15

Author(s):

Jennifer LeRose ◽

Avnish Sandhu ◽

Jordan Polistico ◽

Joe Ellsworth ◽

Mara Cranis ◽

...

Keyword(s):

Blood Culture ◽

Care Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Blood Stream ◽

Central Line ◽

Tertiary Care Center ◽

Blood Stream Infections ◽

Detroit Area ◽

The Impact

Abstract A comparative retrospective study to quantify the impact of Coronavirus Disease 2019 (COVID-19) on patient safety. We found a statistically significant increase in central line-associated blood stream infections and blood culture contamination rates during the pandemic. Increased length of stay and mortality was also observed during COVID-19.

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Molecular epidemiology and antimicrobial susceptibility profiles of methicillin-resistantStaphylococcus aureusblood culture isolates: results of the Quebec Provincial Surveillance Programme

Epidemiology and Infection ◽

10.1017/s095026881400209x ◽

2014 ◽

Vol 143 (7) ◽

pp. 1511-1518 ◽

Cited By ~ 3

Author(s):

S. LÉVESQUE ◽

A. M. BOURGAULT ◽

L. A. GALARNEAU ◽

D. MOISAN ◽

F. DOUALLA-BELL ◽

...

Keyword(s):

Blood Culture ◽

Drug Users ◽

Bloodstream Infections ◽

Central Line ◽

Genomic Relationships ◽

The Usa ◽

Mrsa Strains ◽

Healthcare Associated ◽

Susceptibility Profiles

SUMMARYThe objectives of this study were to characterize methicillin-resistantStaphylococcus aureus(MRSA) blood culture isolates and to determine their relative importance in both nosocomial and community-acquired infections. A total of 535 MRSA blood culture isolates were analysed.In vitrosusceptibility to 14 agents was determined. The genesnuc, mecAand coding for PVL toxin were identified by PCR. All isolates were characterized by PFGE orspatyping to assess their genomic relationships. Most MRSA isolates were retrieved from nosocomial bloodstream infections (474, 89%) and were of the CMRSA2 genotype. Healthcare-associated (HA)-MRSA bloodstream infections were associated with older age (70–89 years,P = 0·002) and most often secondary to central line infections (P = 0·005). Among MRSA strains associated with community-acquired (CA)-MRSA, 28·8% were isolated in intravenous drug users. CA-MRSA genotypes were more frequently found in young adults (20–39 years,P < 0·0001) with skin/soft tissue as the primary sources of infection (P = 0·006). CMRSA10 genotype was the predominant CA-MRSA strain. All MRSA isolates were susceptible to doxycycline, tigecycline, trimethoprim/sulfamethoxazole and vancomycin. Both the presence of the genes coding for PVL toxin (89·8%) and susceptibility to clindamycin (86·5%) were predictive of CA-MRSA genotypes. Whereas in the USA, HA-MRSA have been replaced by USA300 (CMRSA10) clone as the predominant MRSA strain type in positive blood cultures from hospitalized patients, this phenomenon has not been observed in the province of Quebec.

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