scholarly journals Decreasing Blood Culture Contamination Rates Using A Specimen Diversion Device: A Quasi-Experimental Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s468-s468
Author(s):  
Ahmed Babiker ◽  
Aditi Ramakrishnan ◽  
Jessica Howard-Anderson ◽  
Jill Holdsworh ◽  
Mini Jacob ◽  
...  
Keyword(s):  
Experimental Study ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Relative Reduction ◽  
Coagulase Negative Staphylococci ◽  
Total Blood ◽  
Level Change ◽  
Its Analysis ◽  
Quasi Experimental

Background: Blood culture contamination rates are frequently higher than the ≤3% standard in the emergency department (ED). Objective: We sought to determine whether the implementation of a blood diversion device that mechanically sequesters the initial aliquot of the blood culture sample decreased blood culture contamination rates. Methods: We performed a quasi-experimental study in two 500-bed hospitals. The blood-diversion device was implemented in the ED in hospital A, but not in hospital B, starting in January 2018. Preintervention data were collected over a 29-month baseline period, and postintervention data were collected for 20 months. Both hospitals provided ongoing feedback on contamination rates. Blood culture contamination was defined as presence of common skin microbiota (eg, coagulase-negative staphylococci) in only 1 of ≥2 blood culture sets collected within 24 hours. Preintervention and postintervention blood culture contamination rates were calculated based on total blood cultures collected and were compared within and between hospitals using the Wilcoxon rank-sum test. Changes in preintervention and postintervention total and ED contamination rates within hospitals were calculated as rate ratios (RRs) using interrupted time series (ITS) analysis with segmented Poisson regression. Results: Among 212,789 total blood cultures (hospital A, 70,005; hospital B, 142,784), 4,025 (1.8%) were contaminated. In hospital A, the intervention resulted in a decrease in overall median blood culture contamination rates (2.4% vs 1.4%; P < .001) and ED median blood culture contamination rates (4.7% vs 2.6%; P < .001), whereas in hospital B there was no significant change during the same period in overall (2.3% vs 2.0%) or ED (5.0% vs 5.0%) median blood culture contamination rates. In the ITS analysis, the intervention was associated with an immediate decrease in hospital A’s contamination rate by 21.3% (level change RR, 0.79; 95% CI, 0.63–0.98; P = .04) overall and 21.0% (level change RR, 0.79; 95% CI, 0.62–1.0; P =.06) in the ED. After the intervention, there was a continued decrease in hospital A’s overall (trend change RR, 0.95; 95% CI, 0.93–0.97; P < .001) and ED (trend RR, 0.94; 95% CI, 0.92–0.96; P < .001) blood culture contamination rates, but not in hospital B’s overall (trend change RR, 1.02; 95% CI, 1.00–1.02; P = .01) or ED (RR, 1.00; 95% CI, 0.99–1.02; P = .30) blood culture contamination rates during the same period. Conclusions: Implementation of the blood diversion device in the ED resulted in a >20% relative reduction from a baseline of 5% of ED blood culture contamination rates. Continued improvement after implementation suggests ongoing efforts to address the workflow and the culture of safety are needed to optimize the use of this device.Funding: NoneDisclosures: None

scholarly journals 660. Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S432-S432
Author(s):  
Alexander G Hosse
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Nursing Staff ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Contamination Rate ◽  
Culture Collections ◽  
Total Blood ◽  
Primary Driver ◽  
Inpatient Units

Abstract Background Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic. Methods Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units. Results The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units. Figure 1. Comparison of contamination rates in the ED vs the inpatient units from all campuses from September 2019 through September 2020. The blue line represents the hospital goal of 2.25% contamination rate. Solid lines represent total contamination rates including COVID isolation units whereas dotted lines represent units excluding COVID isolation units. Figure 2. Comparison of the non-COVID vs COVID isolation units in the emergency department and inpatient units. The red line represents the hospital goal of less than 2.25% for blood culture contamination rate. Table of Contaminants vs. Total Collected Blood Cultures in Each Unit by Month Figure 3. Raw data from Figure 2. Total blood culture contaminations from each unit by month compared to total blood culture collections from each unit by month. Conclusion Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during. Disclosures All Authors: No reported disclosures

scholarly journals Reducing Blood Culture Contamination; a Quality Improvement Project in Emergency Department

2020 ◽  
Vol 41 (S1) ◽  
pp. s368-s369
Author(s):  
Itisha Gupta ◽  
Jane Codd
Keyword(s):  
Blood Culture ◽  
Positive Culture ◽  
Blood Cultures ◽  
Patient Treatment ◽  
Contamination Rate ◽  
Negative Consequences ◽  
Total Blood ◽  
Improvement Project ◽  
Competency Training ◽  
The Impact

Background: Blood culture is an important investigation in diagnosing sepsis. Positive culture helps to tailor therapy and is crucial in antimicrobial stewardship (AMS). However, positive blood culture does not always denote a bloodstream infection. Sometimes, false-positive results occur because of contamination from organisms outside the bloodstream, leading to significant negative consequences to patient treatment decisions and financial implications. Rates of blood culture contamination vary widely (0.6%–6%) between organizations, and although it is very difficult to eliminate contamination, it can be minimized. Our hospital group has multiple sites including emergency departments (EDs). We have been intermittently monitoring blood culture contamination rates since 2008, which decreased from 6.8% to 4.8% in 2009 but remained static when audited in 2010, 2012, and 2015. Objectives: To reduce our blood culture contamination rate further by targeting 2 busy EDs and by introducing continuous surveillance of blood culture contamination across 3 hospitals beginning in April 2016. Methods: In 2015, for the first time, blood culture contamination rates for both EDs, based in 2 different hospitals, were calculated. The ED results were communicated to the healthcare workers (HCWs), who agreed to establish a continuous surveillance of blood culture contamination and to participate in a reduction plan. Competency training was conducted according to training needs analysis. For example, phlebotomists were trained to ensure the use of the appropriate blood culture kit and educational sessions were tailored to staff groups. The blood culture contamination rate was monitored from April 2016 to March 2019 for 3 hospitals and both EDs to determine the impact of various measures introduced during this time. Results: In 2015, contamination rate of the 3 hospitals was 4.07%, and 10.2% of total blood cultures flagged positive. Also, 25% of blood cultures were requested from Eds, but these samples comprised 54% of the total contamination. The contamination rates for EDs A and B were 7.4% and 10.6%, respectively, which were significantly higher than the overall rate. From April 16 to March 19, there was 22% increase in total blood cultures performed. Results were analyzed quarterly. In total, 8,525 blood culture sets were received in January–March 2019; of these, the EDs contributed 2,799 sets (32.8%). 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. The quarterly decreases were 5.2% and 4.9% in January–March 2019. Conclusions: The emphasis on the sepsis pathway probably led to year-on-year increases in total blood culture sets. Both ED blood culture contamination rates decreased. Consistent efforts in education, training, ensuring competency to various HCW groups, and provision of adequate blood culture kits are important for sustaining these improvements.Funding: NoneDisclosures: None

scholarly journals Frequency of Isolation of Coagulase Negative Staphylococcus from Blood Cultures and its Antibiogram

2021 ◽  
Vol 10 (3) ◽  
pp. 140-144
Author(s):  
Nadia Aslam ◽  
Nazma Kiran ◽  
Naima Mehdi
Keyword(s):  
Tertiary Care ◽  
Blood Cultures ◽  
Diffusion Method ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Coagulase Negative Staphylococci ◽  
Antimicrobial Drugs ◽  
Total Blood ◽  
One Year

Background: Coagulase-negative Staphylococci are members of stable skin inhabitants. They are frequent contaminants in blood cultures and can lead to unnecessary exposure of patients to antimicrobial drugs and excess hospital costs. This study aims to estimate the frequency of Coagulase-negative Staphylococci in blood cultures and their antibiograms. Materials and Methods: This cross-sectional study was performed in a tertiary care hospital over one year from April 2018 to March 2019. Blood cultures received in the laboratory were processed to isolate Coagulase-negative Staphylococci. Susceptibility to various antimicrobial drugs was detected by disc diffusion method and E-strips. Results: A total of 13802 blood cultures were processed in one year. 1750 blood cultures yielded bacterial growth and 374 blood cultures were positive for Staphylococci. Out of these 374 blood cultures, 97 were categorized as Staphylococcus aureus and 277 were Coagulase-negative Staphylococci. Out of 13802 total blood cultures performed during study period, 277 blood cultures positive with Coagulase negative Staphylococcus means contamination rate of 2% out of total blood cultures. 277 Coagulase negative Staphylococcus positive cultures out of 1750 positive blood cultures means contamination rate of 15.8% out of positive blood cultures. Among Coagulase-negative Staphylococci, 68.2% isolates were resistant to Cefoxitin, 95.3% to Penicillin, 85.1% to Erythromycin, 37.5% to Ciprofloxacin, 59.6% to Gentamicin, 68.6% to Fusidic acid, 3.6% to Teichoplanin, and 1.4% to Linezolid. All isolates were sensitive to Vancomycin. Conclusion: The rate of blood culture contamination was 2% out of total blood cultures and 15.8% out of positive blood cultures.

Can the Number of Coagulase-negative Staphylococci Specimens Detected be an Alternative Quality Indicator to the Blood Culture Contamination Rate?

2021 ◽  
Author(s):  
Kei Yamamoto ◽  
Kazuhisa Mezaki ◽  
Norio Ohmagari
Keyword(s):  
Retrospective Study ◽  
Blood Culture ◽  
Receiver Operating Characteristic ◽  
Quality Indicator ◽  
Operating Characteristic ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococci ◽  
Characteristic Curves ◽  
Receiver Operating Characteristic Curves

Abstract Purpose: Coagulase-negative staphylococci (CoNS) are the most frequent contaminating bacteria; hence, we aimed to investigate an indicator of CoNS to predict the increase in blood culture contamination rate (ConR).Methods: We performed a retrospective study of selected patients who underwent blood culture testing.Results: Cases with CoNS-positive blood cultures correlated with ConR (r=0.85). The area under the receiver operating characteristic curves for the number of cases with ConR ≥ 2.5 did not differ statistically from that of the number of cases contaminated by CoNS. Conclusion: The number of CoNS-positive cases could help predict an increase in ConR ≥2.5.

scholarly journals Simple indictor of increased blood culture contamination rate by detection of coagulase-negative staphylococci

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kei Yamamoto ◽  
Kazuhisa Mezaki ◽  
Norio Ohmagari
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Blood Cultures ◽  
Clinical Aspects ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococci ◽  
Confidential Interval ◽  
Prediction Ability

AbstractCoagulase-negative staphylococci (CoNS) are the most frequent contaminating bacteria; therefore, we aimed to investigate an indicator of CoNS to predict the increase in blood culture contamination rate (ConR). We performed a retrospective study of selected patients, who underwent blood culture testing. Contamination was defined as the presence of either one of two or more sets of skin-resident bacteria, except for cases with a low likelihood of contamination based on clinical aspects. We calculated the monthly ConR [(total number of contaminated cases per month)/(total number of blood culture sets collected per month) × 100] and analysed the ConR prediction ability using the following four indicators: the number of CoNS-positive sets of blood cultures, cases with at least one CoNS-positive blood culture set, cases with only one CoNS-positive blood culture set, and cases of contamination by CoNS. Cases with CoNS-positive blood cultures correlated with ConR (r = 0.85). Although the area under the receiver operating characteristic curve for the number of cases with ConR ≥ 2.5 differed significantly from that of the number of cases contaminated by CoNS, the negative predictive value was high, reaching up to 95.5% (95% confidential interval 87.3–99.1). The number of CoNS-positive cases could help predict an increase in ConR ≥ 2.5.

Distinguishing Sepsis From Blood Culture Contamination in Young Infants With Blood Cultures Growing Coagulase-Negative Staphylococci

PEDIATRICS ◽  
1990 ◽  
Vol 86 (2) ◽  
pp. 157-162
Author(s):  
Joseph W. St Geme ◽  
Louis M. Bell ◽  
Stephen Baumgart ◽  
Carl T. D'Angio ◽  
Mary Catherine Harris
Keyword(s):  
Blood Culture ◽  
Peripheral Blood ◽  
Clinical Information ◽  
Study Groups ◽  
Blood Cultures ◽  
High Risk Population ◽  
Coagulase Negative Staphylococci ◽  
Peripheral Blood Culture ◽  
Young Infants ◽  
Initial Culture

Coagulase-negative staphylococci represent the most common cause of serious nosocomial infection in many intensive care nurseries. However, these organisms are also common blood culture contaminants. To determine the value of quantitative blood cultures in distinguishing sepsis from culture contamination, we reviewed records of all infants in our nurseries who had peripheral blood isolates of coagulase-negative staphylococci during a 3-year period. Twenty-three episodes of sepsis were identified in 21 infants, and 10 infants had blood culture contamination. Colony counts from the initial peripheral blood culture were significantly different for the two study groups (P &lt; .001). In 9 of 23 episodes of sepsis, the initial peripheral blood culture grew &gt;100 colony-forming units (cfu) per mL. In the other 14 episodes, the initial culture yielded ≤50 cfu/mL. All 10 infants with culture contamination had colony counts of &lt;50 cfu/mL, and in 9 the initial peripheral blood culture grew &lt;20 cfu/mL. Infants with sepsis, including those with colony counts of ≤50 cfu/mL, were significantly more likely to have a central catheter or an abnormal hematologic value or both (P &lt; .05). Infants who lacked these clinical features were more likely to have contamination. We conclude that quantitative blood cultures in conjunction with specific clinical information may distinguish sepsis from culture contamination with coagluase-negative staphylococci in young infants. In addition, low colony-count growth should not be ignored as contamination in this high-risk population.

scholarly journals Antimicrobial Stewardship Standards and Patient Safety: A Case Study in Blood Culture Contamination

2021 ◽  
Vol 1 (S1) ◽  
pp. s36-s36
Author(s):  
Connie Schaefer
Keyword(s):  
Blood Culture ◽  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Standard Method ◽  
Broad Spectrum ◽  
Emergency Departments ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Broad Spectrum Antibiotics ◽  
Contamination Events

Background: Blood culture is a crucial diagnostic tool for healthcare systems, but false-positive results drain clinical resources, imperil patients with an increased length of stay (and associated hospital-acquired infection risk), and undermine global health initiatives when broad-spectrum antibiotics are administered unnecessarily. Considering emerging technologies that mitigate human error factors, we questioned historically acceptable rates of blood culture contamination, which prompted a need to promote and trial these technologies further. In a 3-month trial, 3 emergency departments in a midwestern healthcare system utilized an initial specimen diversion device (ISDD) to draw blood cultures to bring their blood culture contamination rate (4.4% prior to intervention) below the 3% benchmark recommended by the Clinical & Laboratory Standards Institute. Methods: All emergency department nursing staff received operational training on the ISDD for blood culture sample acquisition. From June through August 2019, 1,847 blood cultures were drawn via the ISDD, and 862 were drawn via the standard method. Results: In total, 16 contamination events occurred when utilizing the ISDD (0.9%) and 37 contamination events occurred when utilizing the standard method (4.3%). ISDD utilization resulted in an 80% reduction in blood culture contamination from the rate of 4.4% rate held prior to intervention. Conclusions: A midwestern healthcare system experienced a dramatic reduction in blood culture contamination across 3 emergency departments while pilot testing an ISDD, conserving laboratory and therapeutic resources while minimizing patient exposure to unnecessary risks and procedures. If the results obtained here were sustained and the ISDD utilized for all blood culture draws, nearly 400 contamination events could be avoided annually in this system. Reducing unnecessary antibiotic use in this manner will lower rates of associated adverse events such as acute kidney injury and allergic reaction, which are possible topics for further investigation. The COVID-19 pandemic has recently highlighted both the importance of keeping hospital beds available and the rampant carelessness with which broad-spectrum antibiotics are administered (escalating the threat posed by multidrug-resistant organisms). As more ambitious healthcare benchmarks become attainable, promoting and adhering to higher standards for patient care will be critical to furthering an antimicrobial stewardship agenda and to reducing treatment inequity in the field.Funding: NoDisclosures: None

scholarly journals Molecular epidemiology of catheter-related bloodstream infections caused by coagulase-negative staphylococci in haematological patients with neutropenia

2004 ◽  
Vol 132 (5) ◽  
pp. 921-925 ◽  
Author(s):  
M. MÜLLER-PREMRU ◽  
P. ČERNELČ
Keyword(s):  
Blood Culture ◽  
Staphylococcus Epidermidis ◽  
Clinical Signs ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Blood Cultures ◽  
Peripheral Vein ◽  
Central Venous ◽  
Coagulase Negative Staphylococci ◽  
Haematological Patients

Catheter-related bloodstream infection (CRBSI) caused by coagulase-negative staphylococci (CNS) is common in haematological patients with febrile neutropenia. As the clinical signs of CRBSI are usually scarce and it is difficult to differentiate from blood culture contamination, we tried to confirm CRBSI by molecular typing of CNS isolated from paired blood cultures (one from a peripheral vein and another from the central venous catheter hub). Blood cultures were positive in 59 (36%) out of 163 patients. CNS were isolated in 24 (40%) patients; in 14 from paired blood cultures (28 isolates) and in 10 from a single blood culture. CNS from paired blood cultures were identified as Staphylococcus epidermidis. Antimicrobial susceptibility was determined and bacteria were typed by pulsed-field gel electrophoresis (PFGE) of bacterial genomic DNA. In 13 patients, the antibiotic susceptibility of isolates was identical. The PFGE patterns from paired blood cultures were identical or closely related in 10 patients, thus confirming the presence of CRBSI. In the remaining four patients they were unrelated, and suggested a mixed infection or contamination. Since CNS isolates from three patients had identical PFGE patterns, they were probably nosocomially spread amongst them.

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

Blood Culture Contamination in the Clinical Microbiology Laboratory of a Teaching Hospital

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S133-S133
Author(s):  
Kemin Xu ◽  
Sarwat Gilani ◽  
Hank Wang ◽  
John Fallon
Keyword(s):  
Blood Culture ◽  
Teaching Hospital ◽  
Clinical Microbiology ◽  
Diagnostic Errors ◽  
Blood Cultures ◽  
Bacillus Species ◽  
Contamination Rate ◽  
Clinical Microbiology Laboratory ◽  
Current Guideline ◽  
Tertiary Teaching

Abstract Objectives Blood culture is one of the most important tests performed in clinical microbiology laboratories. However, blood culture contamination remains a problematic cause of diagnostic errors for laboratory diagnosis and patient management. This aim of this study was to determine blood culture contamination rates and tendency at Westchester Medical Center (WMC), a tertiary teaching hospital in suburban New York City. Methods All blood culture tests at WMC received from January 2017 to December 2018, as well as some historical data from 2007 to 2014, were retrospectively retrieved. Blood culture contamination rates were determined according to the laboratory’s predefined criteria. Results From 2007 to 2014, a total of 209,750 blood cultures were performed with an average contamination rate of 1.6% (ranging from 0.4% to 3.5% monthly). The total numbers of blood cultures performed in 2017 and 2018 were 27,863 and 28,047, respectively. The overall positive rate of blood culture was 6.8% in 2017 and 7.6% in 2018. The contamination rate of blood culture was 0.6% in 2017 and 0.9% in 2018 with very few variations among different months of the year, which was significantly lower than that of the national benchmark (~2.5%) on blood culture contamination. The majority of contaminants were Staphylococcus epidermidis, accounting for 87% of source contamination, followed by Corynebacterium species (5.5%), Bacillus species and Micrococcus species (3.5% each), and Propionibacterium species (0.5%). Conclusion Adherence to current guideline on appropriate blood collection techniques and monthly monitoring and timely feedback to phlebotomists should be continued to keep a low contamination rate for blood culture, which is not only from the perspective of individual patient care but also from the standpoint of hospital epidemiology and public health.

Sign in / Sign up

Export Citation Format

Share Document