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.

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.

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 Regression Discontinuity of Blood Culture Contamination Rate After Changing of Disinfectants: Retrospective Observational Study

2021 ◽  
Author(s):  
Koshi Ota ◽  
Daisuke Nishioka ◽  
Yuri Ito ◽  
Emi Hamada ◽  
Naomi Mori ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Observational Study ◽  
Regression Discontinuity ◽  
Blood Cultures ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Contamination Rate ◽  
Blood Collection ◽  
Contaminated Blood

Abstract Background: Blood cultures are indispensable for detecting life-threatening bacteremia. Little is known about associations between contamination rates and topical disinfectants for blood collection in adults.Objective: We sought to determine whether a change in topical disinfectants was associated with the rates of contaminated blood cultures in the emergency department of a single institution.Methods: This single-center, retrospective observational study of consecutive patients aged 20 years or older was conducted in the emergency department (ED) of a university hospital in Japan between August 1, 2018 and September 30, 2020. Pairs of blood samples were collected for aerobic and anaerobic culture from the patients in the ED. Physicians selected topical disinfectants according to their personal preference before September 1, 2019; alcohol/chlorhexidine gluconate (ACHX) was mandatory thereafter, unless the patient was allergic to alcohol. Regression discontinuity analysis was used to detect the effect of the mandatory usage of ACHX on rates of contaminated blood cultures.Results: We collected 2,141 blood culture samples from 1097 patients and found 164 (7.7%) potentially contaminated blood cultures. Among these, 445 (20.8%) were true bacteremia and 1,532 (71.6%) were true negatives. Puncture site disinfection was performed with ACHX for 1,345 (62.8%) cases and with povidone-iodine (PVI) for 767 (35.8%) cases. The regression discontinuity analysis showed that mandatory ACHX usage significantly reduced the blood culture contamination rate by 9.6% (95% confidence interval (CI): 5.0%–14.2%, P <0.001).Conclusion: Rates of contaminated blood cultures were significantly lower when ACHX was used as the topical disinfectant.

scholarly journals 157. Reducing Blood Culture Contamination Rates Through the Use of a Red Top Tube Discard

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S12-S13
Author(s):  
Bharat Ramlal ◽  
Rosemary Renouf ◽  
Jaber Aslanzadeh
Keyword(s):  
Blood Culture ◽  
Effective Means ◽  
Accurate Determination ◽  
Laboratory Diagnosis ◽  
The United States ◽  
Culture Collection ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Blood Contamination ◽  
Blood Draw

Abstract Background Septicemia is a major cause of death in the United States and accounts for up to $16.7 billion in annual health care expenses. Blood culture is the gold standard for laboratory diagnosis of bacteremia and resultant septicemia; however, false-positive blood cultures hinder the accurate determination of true bacteremia with often serious implications. The goal of this study was to determine the efficacy of collecting a 1 mL discard in a red tube prior to blood culture collection and to assess its effectiveness in reducing contamination rates in Hartford Hospital Emergency Department (HHED). Methods During the months of June to December 2017 blood cultures were collected by the phlebotomy team using ChloraPrep (chlorhexidine) as the sole disinfecting agent. Blood cultures consisted of BD BACTEC plus Aerobic/F and BD BACTEC Lytic/10 Anaerobic drawn at the same time and monitored on BD BACTEC FX instrument for 5 days. Prior to collecting blood cultures 1 mL of blood was collected in a red top tube and discarded. Monthly and overall contamination rates were then compared with 2016 in which a red top discard tube was not used. Results During June to December 2016, there were a total of 9,576 blood cultures collected with a total of 178 contaminants and an overall contamination rate of 1.9%. During June to December 2017, there were a total of 9,133 blood cultures collected with a total of 73 contaminants and an overall contamination rate of 0.8%. During both years, our contamination rates were well below the CLSI recommendation; however, a significant reduction in blood culture contamination was observed after the use of a Red Top discard tube (0.8% vs. 1.9%) (Figures 1–3). Conclusion The cost of a standard blood draw with Red Top tubes is minimal (few cents) while a single collection using an initial specimen diversion device (ISDD) can range from $15 to $18. During the course of this study, the use of a standard Red Top discard cost approximately $456 (2017); if an ISDD was used instead, this would have generated $136,995 in healthcare cost. At our institution, we were able to keep our contamination rates below 1% after the implementation of a standard Red Top discard tube. This suggests that the use of a Red Top discard prior to blood culture collection is an effective means for reducing and maintaining a low blood contamination rate. Disclosures All authors: No reported disclosures.

scholarly journals Regression discontinuity of blood culture contamination rate after changing of disinfectants: retrospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Koshi Ota ◽  
Daisuke Nishioka ◽  
Yuri Ito ◽  
Emi Hamada ◽  
Naomi Mori ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Observational Study ◽  
Regression Discontinuity ◽  
Blood Cultures ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Contamination Rate ◽  
Blood Collection ◽  
Contaminated Blood

AbstractBlood cultures are indispensable for detecting life-threatening bacteremia. Little is known about associations between contamination rates and topical disinfectants for blood collection in adults. We sought to determine whether a change in topical disinfectants was associated with the rates of contaminated blood cultures in the emergency department of a single institution. This single-center, retrospective observational study of consecutive patients aged 20 years or older was conducted in the emergency department (ED) of a university hospital in Japan between August 1, 2018 and September 30, 2020. Pairs of blood samples were collected for aerobic and anaerobic culture from the patients in the ED. Physicians selected topical disinfectants according to their personal preference before September 1, 2019; alcohol/chlorhexidine gluconate (ACHX) was mandatory thereafter, unless the patient was allergic to alcohol. Regression discontinuity analysis was used to detect the effect of the mandatory usage of ACHX on rates of contaminated blood cultures. We collected 2141 blood culture samples from 1097 patients and found 164 (7.7%) potentially contaminated blood cultures. Among these, 445 (20.8%) were true bacteremia and 1532 (71.6%) were true negatives. Puncture site disinfection was performed with ACHX for 1345 (62.8%) cases and with povidone-iodine (PVI) for 767 (35.8%) cases. The regression discontinuity analysis showed that mandatory ACHX usage was significantly associated with lower rates of contaminated blood cultures by 9.6% (95% confidence interval (CI): 5.0%–14.2%, P < 0.001). Rates of contaminated blood cultures were significantly lower when ACHX was used as the topical disinfectant.

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.

Risk factors and clinical outcomes associated with blood culture contamination

2021 ◽  
pp. 1-7
Author(s):  
Justin M. Klucher ◽  
Kevin Davis ◽  
Mrinmayee Lakkad ◽  
Jacob T. Painter ◽  
Ryan K. Dare
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Patient Specific ◽  
Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

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

2018 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
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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