Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department

2010 ◽  
Vol 31 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Lauren Marlowe ◽  
Rakesh D. Mistry ◽  
Susan Coffin ◽  
Kateri H. Leckerman ◽  
Karin L. McGowan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Povidone Iodine ◽  
Chlorhexidine Gluconate ◽  
Series Data ◽  
Control Group ◽  
Contamination Rate ◽  
Peripheral Blood Culture ◽  
Skin Antisepsis

Objective.To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.Design.Retrospective, quasi-experimental study.Setting.Emergency department of a tertiary care children's hospital.Patients.Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.Methods.Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).Results.Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P< .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P= .337).Conclusion.Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

Blood Culture Contamination A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

2013 ◽  
Vol 34 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Laraine L. Washer ◽  
Carol Chenoweth ◽  
Hae-Won Kim ◽  
Mary A. M. Rogers ◽  
Anurag N. Malani ◽  
...  
Keyword(s):  
Blood Culture ◽  
Peripheral Blood ◽  
Culture Collection ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Peripheral Blood Culture ◽  
Skin Antisepsis ◽  
Intent To Treat ◽  
Random Crossover ◽  
Contaminated Blood

Objective.To determine relative rates of blood culture contamination for 3 skin antisepsis interventions—10% povidone iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% Chlorhexidine gluconate in 70% isopropyl alcohol (CHG)—when used by dedicated phlebotomy teams to obtain peripheral blood cultures.Design.Randomized crossover trial with hospital floor as the unit of randomization.Setting.Teaching hospital with 885 beds.Patients.All adult patients undergoing peripheral blood culture collection on 3 medical-surgical floors from May 2009 through September 2009.Intervention.Each antisepsis intervention was used for 5 months on each study floor, with random crossover after a 1-month washout period. Phlebotomy teams collected all peripheral blood cultures. Each positive blood culture was adjudicated by physicians blinded to the intervention and scored as a true positive or contaminated blood culture. The primary outcome was the rate of blood culture contamination for each antisepsis agent.Results.In total, 12,904 peripheral blood culture sets were evaluated, of which 735 (5.7%) were positive. There were 98 contaminated cultures, representing 13.3% of all positive cultures. The overall blood culture contamination rate for the study population was 0.76%. Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics (P = .18), yielding 0.58% with PI (95% confidence interval [CI], 0.38%-0.86%), 0.76% with IT (95% CI, 0.52%-1.07%), and 0.93% with CHG (95% CI, 0.67%-1.27%).Conclusion.Choice of antiseptic agent does not impact contamination rates when blood cultures are obtained by a phlebotomy team and should, therefore, be based on costs or preference.Trial Registration.ClinicalTrials.gov identifier: NCT01216761.

Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination

2002 ◽  
Vol 23 (7) ◽  
pp. 397-401 ◽  
Author(s):  
Barbara W. Trautner ◽  
Jill E. Clarridge ◽  
Rabih O. Darouiche
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Isopropyl Alcohol ◽  
Tertiary Care ◽  
Chlorhexidine Gluconate ◽  
The Other ◽  
Contamination Rate ◽  
Skin Preparation ◽  
Skin Antisepsis

Objective:Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.Design:Prospective, blinded clinical trial.Setting:Tertiary-care teaching hospital.Patients:Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.Interventions:House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.Results:Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%;P= .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.Conclusions:Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.

scholarly journals 1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S556-S557
Author(s):  
Derek Tam ◽  
Kyle Hengel ◽  
Aparna Arun
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Peripheral Blood ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Bottle ◽  
Children's Hospital ◽  
Peripheral Blood Culture ◽  
Children’S Hospital

Abstract Background Positive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%. Methods We initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced. Results The pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively. Conclusion The departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture. Disclosures All authors: No reported disclosures.

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.

Accuracy of procalcitonin for diagnosing peripheral blood culture contamination among patients with positive blood culture for potential contaminants

Infection ◽  
2021 ◽  
Author(s):  
Clémence Berthezène ◽  
Nejla Aissa ◽  
Anne Elisabeth Manteaux ◽  
Jean-Louis Guéant ◽  
Abderrahim Oussalah ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Peripheral Blood ◽  
Peripheral Blood Culture

scholarly journals Comparison of the Contamination Rate and Risk Factor Profile of Blood Culture Done in Emergency Department and MHDU/MICUs

2021 ◽  
pp. 1-8
Author(s):  
Dr. Pankaj Kumar Singh
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Blood Culture ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Contamination Rate ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Factors Associated

Aims and objectives: To determine the risk factors of blood culture contamination done in ED and those done in the MHDU/MICU among patients admitted with medical illness. Material and Methods: This is a two months’ prospective observational study comparing blood culture contamination rate and risk factors associated with contamination between ED and MICU/MHDU. A total of 998 patients were included in the study who underwent blood culture in ED and MICU/MHDU. 570 in ED and 428 in MICU/MHDU were included after meeting exclusion and inclusion criteria. Results: Blood culture growths were higher in ED (19%). Most common growth was CoNS (4%). The overall contamination rate in this study was (4.8%) The contamination rate was lower in ED (4.4%) when compared to MICU/MHDU (5.4%).

Peripheral blood culture contamination in adults and venepuncture technique: prospective cohort study

2007 ◽  
Vol 61 (4) ◽  
pp. 509-513 ◽  
Author(s):  
A Qamruddin ◽  
N Khanna ◽  
D Orr
Keyword(s):  
Cohort Study ◽  
Blood Culture ◽  
Prospective Cohort Study ◽  
Peripheral Blood ◽  
Prospective Cohort ◽  
Univariate Analysis ◽  
Blood Collection ◽  
Peripheral Blood Culture ◽  
Protocol Compliance ◽  
Hospital Protocol

Aims:To test the hypothesis that compliance with a hospital protocol on peripheral blood culture (PBC) collection in adults is associated with a reduction in PBC contamination, and to investigate likely contributing factors for contamination.Methods:A prospective cohort study was conducted, utilising data collection by participant questionnaire completion, and utilising bacteriology laboratory results on PBCs. Participants were all healthcare workers involved in obtaining PBCs from adults.Results:1460 PBCs with questionnaires were received. Contamination among the 1460 PBCs as a whole was 8.8%. 766 of the questionnaires were sufficiently complete to allow analysis of blood culture contamination in relation to protocol compliance. Among these, protocol compliance was 30% and contamination was 8.0%. When the protocol was complied with, 2.6% of PBCs were contaminated, but when the protocol was not followed, contamination was significantly higher at 10.3% (OR 4.35, 95% CI 1.84 to 12.54). Univariate analysis on all 1460 PBCs suggested that the site for blood collection, and disinfection of the venepuncture site were important factors in PBC contamination: when no venepuncture site disinfection was performed, contamination was significantly higher than when alcohol was used (5.1% versus 15.8%, OR 3.46, 95% CI 2.01 to 5.97); when a PBC collection site other than a fresh peripheral vein was used, contamination was significantly higher (7.3% versus 12.0%, OR 1.75, 95% CI 1.03 to 2.96).Conclusions:Compliance with a hospital protocol on PBC collection technique in adults significantly reduces blood culture contamination.

scholarly journals Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

2016 ◽  
Vol 54 (12) ◽  
pp. 3007-3009 ◽  
Author(s):  
Elizabeth Story-Roller ◽  
Melvin P. Weinstein
Keyword(s):  
Blood Culture ◽  
Crossover Study ◽  
Clinical Care ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
University Hospital ◽  
Contamination Rate ◽  
Nursing Unit ◽  
Skin Antisepsis ◽  
Randomized Crossover Study

Blood cultures (BCs) are the standard method for diagnosis of bloodstream infections (BSIs). However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, potentially resulting in unnecessary antibiotic use and excessive therapy costs. Several studies have compared various skin antisepsis agents without a clear consensus as to which agent is most effective in reducing contamination. A prospective, randomized crossover study directly comparing blood culture contamination rates using chlorhexidine versus iodine tincture for skin antisepsis was performed at Robert Wood Johnson University Hospital (RWJUH). Eight nursing units at RWJUH were provided with blood culture kits containing either chlorhexidine (CH) or iodine tincture (IT) for skin antisepsis prior to all blood culture venipunctures, which were obtained by nurses or clinical care technicians. At quarterly intervals, the antiseptic agent used on each nursing unit was switched. Analyses of positive BCs were performed to distinguish true BSIs from contaminants. Of the 6,095 total BC sets obtained from the participating nursing units, 667 (10.94%) were positive and 238 (3.90%) were judged by the investigators to be contaminated. Of the 3,130 BCs obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of 2,965 BCs obtained using CH, 327 (11.03%) were positive and 115 (3.88%) were contaminated. The rates of contaminated BCs were not statistically significant between the two antiseptic agents (P= 1.0). We conclude that CH and IT are equivalent agents for blood culture skin antisepsis.

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