Blood Culture Pilot Lean Study: Monthly Comparison of Blood Culture Isolation Rate in 2010 and the Implementation of a Blood Collection Kit in the Emergency Room to Reduce Contamination

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.

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METHOD FOR OBTAINING BLOOD CULTURE WHILE DIAGNOSING BLOODSTREAM INFECTION

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-3-185-190 ◽

2020 ◽

Vol 65 (3) ◽

pp. 185-190

Author(s):

N. M. Kargaltseva ◽

V. I. Kocherovets ◽

A. Yu. Mironov ◽

O. Yu. Borisova

Keyword(s):

Blood Culture ◽

Blood Sample ◽

Bloodstream Infection ◽

Blood Volume ◽

Venous Blood ◽

Buffy Coat ◽

Blood Cultures ◽

Genetic Identification ◽

Blood Collection ◽

Urogenital System

Diagnosing of bloodstream infection (BSI) in outpatients is essential. A large blood volume is required to obtain blood culture (CLSI): 2 sets, 40ml of blood for diagnosing in 95% cases of bacteremia. Molecular-genetic methods can not replace blood culture method, but they accelerate the identification of any pathogen. Culturomics gives a combination of different conditions for isolating microorganisms from a sample and along with their genetic identification. We used the patent method for direct inoculation of buffy-coat from 4,5ml of a venous blood sample and MALDI-ToF identification method. In 382 outpatients examined there were received 183 blood cultures (48,0%), more often among women (65,6%) and young people (74,9%). The causative agents of community-acquired bloodstream infection were aerobes (73,4%), anaerobes (24,2%), fungi (2,4%). The gram-positive cocci were prevailing (51,4%) and the gram-negative rods were isolated rather seldom (9,6%). BSI was monomicrobial (66,5%) and polymicrobial (33,5%). Polymicrobial blood cultures had 2, 3, 4 agents in one blood sample (75,4%, 18,8%, 5,8%, respectively). There were also found combinations of different species of aerobes (47,8%), aerobes with anaerobes (42%). BSI caused complications of the primary disease of the respiratory system, urogenital system and in 100% of cases after plastic surgery. A small blood volume is required for buffy-coat inoculation, the direct agar culture reduces the response time to 2 days, so it makes genetic identification possible on the 2nd day from the moment of blood collection.

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1148. Reduction of Blood Culture Contamination Rates by an Altered Sampling Protocol: Single-Center, Prospective, Randomized, Controlled, Open-Label Trial

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.981 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S345-S345

Author(s):

Jacob Strahilevitz ◽

Or Svinik ◽

Alon Lalezari ◽

Odaya Tel-Zur ◽

Shlomo Sinvani ◽

...

Keyword(s):

Blood Culture ◽

Standard Method ◽

Standard Procedure ◽

Real Life ◽

Medical Personnel ◽

Blood Chemistry ◽

Test Tube ◽

Blood Cultures ◽

Blood Collection ◽

Open Label

Abstract Background Contaminated blood cultures remain a challenge for patients, physicians, and microbiology laboratories, often leading to unnecessary antibiotic treatment. One approach to reduce contamination is to avoid culturing the initial blood sample that can contain a contaminated plug of skin from the needle stick. Initial specimen diversion technique (ISDT) was associated with decreased rate of blood culture contamination, when applied by trained phlebotomists, using either sterile vacuum blood collection tubes or a designated device. The aim of this study was to test ISDT in real-life, using externally nonsterile regular vacuum sample tubes for the diversion, by any medical personnel taking blood cultures. Methods Adults from whom the treating physician planned to take blood cultures and additional blood chemistry tests, in the same venous puncture, were eligible and were randomly assigned to intervention or control arms. The hospital’s standard procedure for blood drawing was maintained, except that in the intervention arm, blood was aspirated to a green-capped tube, which was used for regular biochemistry tests, prior to the blood culture. Results Four hundred twenty-three blood cultures were obtained from 404 patients. Of 404 (11.1%) of the blood cultures, 45 yielded microbial growth, with 31 (7.7%) regarded as true pathogens and 14 (3.5%) as contaminants. Detection of true bloodstream infection was similar by the two methods, 16/181 (8.83%) with the ISDT, and 15/223 (6.72%) using the standard method. The ISDT was associated with a significantly less isolation of presumed contaminants compared with the standard method, 2/165 (1.2%) vs. 12/208 (5.76%), P = 0.02. Conclusion ISDT, by any medical personnel, through altered order of test tube vs. blood culture sampling significantly reduced contamination of blood cultures without loss of diverted blood. Disclosures All authors: No reported disclosures.

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Trends in Blood Culture Contamination: A College of American Pathologists Q-Tracks Study of 356 Institutions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2005-129-1222-tibcca ◽

2005 ◽

Vol 129 (10) ◽

pp. 1222-1225 ◽

Cited By ~ 4

Author(s):

Leonas G. Bekeris ◽

Joseph A. Tworek ◽

Molly K. Walsh ◽

Paul N. Valenstein

Keyword(s):

Blood Culture ◽

Monitoring Program ◽

Mixed Linear Model ◽

Cost Of Care ◽

Contamination Rate ◽

Blood Collection ◽

Patient Centered ◽

Data Set ◽

Sustained Reduction ◽

Definition Of

Abstract Context.—Blood culture contamination extends hospital stays and increases the cost of care. Objectives.—To measure blood culture contamination rates in a large number of institutions over time and to elucidate practice patterns and demographic factors associated with sustained reduction in contamination rates. Design.—Longitudinal cohort study of 356 clinical laboratories that provided quarterly data about blood culture results, using a uniform definition of contamination. Mixed linear model analysis of the 1999 through 2003 data set. Results.—Blood culture contamination was significantly higher in institutions that used nonlaboratory personnel to collect blood (P = .03) and significantly lower in facilities that used a dedicated phlebotomy team (P < .001). Higher volume of blood collection was significantly associated with lower contamination rates (P < .001). Continued participation in the Q-Tracks monitoring program was associated with significant and progressive reduction in contamination rates. By the fifth year of participation, the median institution had reduced its blood culture contamination rate by 0.67% (P < .001). Conclusions.—Institutions that use decentralized patient-centered personnel rather than dedicated phlebotomy teams to collect blood cultures experience significantly higher contamination rates. Long-term monitoring of contamination is associated with sustained improvement in performance.

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Emergency Room Visits in Children with Hemophilia

Blood ◽

10.1182/blood.v118.21.1227.1227 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1227-1227

Author(s):

Ayesha N Zia ◽

Bulent Ozgonenel ◽

Meera B. Chitlur ◽

Madhvi Rajpurkar ◽

Michael Callaghan ◽

...

Keyword(s):

Head Injury ◽

Blood Culture ◽

Emergency Room ◽

Intracranial Hemorrhage ◽

Positive Blood Culture ◽

Motor Vehicle ◽

Screening Tests ◽

Clotting Factor ◽

Cranial Ct ◽

Ct Examination

Abstract Abstract 1227 Introduction: The emergency room (ER) management of bleeding and other complications of hemophilia constitutes an important component of hemophilia therapy. In this retrospective study, we examined the ER visits of children with hemophilia during a five-year period. Methods: Electronic medical records of all ER visits to our hospital were reviewed for hemophilia patients aged 0–21 years between January 1st, 2006- December 31st, 2010. ER visits were categorized as visits related to injury or bleeding; visits related to fever or a positive blood culture in a patient with central venous catheter (CVC); visits for general pediatric causes unrelated to hemophilia; and visits for clotting factor infusion. Results: There were 518 ER visits from 79 male patients (71 hemophilia A and 8 hemophilia B) over the 5-year period. Median age was 5 years (range 0–21). Five patients had other chronic conditions in addition to hemophilia: sickle cell anemia in 2 patients and Down syndrome, Crohn disease, and myelomeningocele in one patient each. The reasons for ER visits were as follows: 60.8% (n=315) were for injury and/or bleeding; 12.2% for either fever in a patient with CVC (n=53) or positive results of a blood culture drawn earlier from a CVC (n=10); 18.0% (n=93) for pediatric causes unrelated to hemophilia; and 9.1% (n=47) for clotting factor infusion. Four of the visits were because of a bleeding episode in patients not yet diagnosed with hemophilia. Computerized tomographic (CT) examination of the head was undertaken in 85 of the visits: trauma to the head (n=68), face (n=2), nose (n=1), or eyes (n=2); after falling backward (n=1) and motor vehicle accident (n=2) without a reported head injury; other symptoms such as headache (n=6), lethargy (n=1), pallor (n=1), and vomiting (n=1). In 6 patients with head injury, the cranial CT examination was deferred because of a normal neurologic examination. Only 4.7% (n=4) of the cranial CT examinations showed intracranial hemorrhage. These patients had presented with head trauma (n=2), vomiting (n=1), and headache (n=1). Of the 53 febrile visits in patients with CVC, blood cultures grew an organism in 43.4% (n=23) of the cases. As two of the visits for a positive blood culture were for cultures drawn in the ER the day before, there were a total of 31 visits with a new positive blood culture from a CVC: 14 with single gram-positive bacteria, 9 with single gram-negative bacteria, and 8 with multiple organisms, including two with Candida species. Conclusions: Children with hemophilia present to the ER mostly for bleeding or injury-related reasons. Head injury or headache may prompt a cranial CT examination in patients with hemophilia; however, only a minority of such patients has intracranial hemorrhage, and a good neurologic assessment should help determine patients who require this investigation. Fever in a hemophiliac patient with CVC is a serious symptom, as almost half of such children might have bacteremia. Although uncommon, undiagnosed hemophilia patients may present with their first hemorrhagic episode to the ER, and appropriate screening tests should be ordered in the event of a clinical suspicion Disclosures: No relevant conflicts of interest to declare.

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Blood Culture Procedures in a Busy Emergency Room: Balancing or Biasing Groups During Randomization

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1794 ◽

2020 ◽

Cited By ~ 1

Author(s):

Tetsuro Aita ◽

Sugihiro Hamaguchi ◽

Hiroaki Nakagawa ◽

Sei Takahashi ◽

Toru Naganuma ◽

...

Keyword(s):

Blood Culture ◽

Emergency Room

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Effect of blood volume in automated blood culture of the BACT/ALERT 3D system on isolation rate and time to positivity of pathogens, in a tertiary care hospital, South India

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2019.040 ◽

2020 ◽

Vol 5 (4) ◽

pp. 176-180

Author(s):

Apurba Sankar Sastry ◽

◽

Nayana Thankam Binu ◽

Anitha G ◽

Deepashree ◽

...

Keyword(s):

Blood Culture ◽

Blood Volume ◽

South India ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Isolation Rate ◽

Time To Positivity

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

10.21203/rs.3.rs-754189/v1 ◽

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.

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