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

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

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.66 ◽

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

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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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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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Quality Improvement Project Demonstrate that Prolonged Pre-Analytical Time Does Not Lead to False Negative Blood Cultures

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.307 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S140-S140

Author(s):

E Abada ◽

M Y Khan ◽

N Yerrapotu ◽

V Pardeshi ◽

F Zaiem ◽

...

Keyword(s):

Blood Culture ◽

Medical Center ◽

False Negative ◽

Bloodstream Infections ◽

Blood Cultures ◽

Coagulase Negative Staphylococcus ◽

Blood Collection ◽

Improvement Project ◽

Negative Culture ◽

Analytical Time

Abstract Introduction/Objective Bacterial infection is a significant cause of morbidity and mortality. Prompt identification of microorganisms and their susceptibilities to antimicrobial therapies is critical in the management of patients with bloodstream infections. Blood cultures are collected in paired aerobic and anaerobic bottles. However, transport delays might allow some organisms to grow extensively prior to incubation in the blood culture instruments, leading to false-negative culture results. The Detroit Medical Center utilizes the BD Bactec™ instruments for blood culture incubation and the Verigene DNA-based molecular assay for the identification of bacteria and major resistance genes. It has a core microbiology lab that serves 6 hospitals, however, 2 of the hospitals are remotely located. The aim of this project was to determine if transportation delays led to significant false-negative culture results. If significant false negativity occurred, additional Bactec™ instruments would need to be purchased. Methods For one month, we tracked the collection of blood cultures to incubation time at one of the remote hospitals. All blood cultures that remain negative after 164 hours of incubation are routinely discarded. However, in this case, they were subcultured to a Petri plate containing chocolate agar for 30 days. Any organisms that grew were identified by standard lab techniques. Results Of the 547 negative culture bottles that were subcultured for possible false-negative results, only 3 (0.5%) bottles grew bacteria. All three were isolated from different patients. The mean time from blood collection to incubation in the instrument was 4-8 hours. The isolates either met criteria for contaminated cultures, or they grew the same pathogen that had previously been identified in the paired bottle from the same culture. The organisms isolated include coagulase negative Staphylococcus species, Staphylococcus pettenkoferi, and Pseudomonas aeruginosa. No unexpected pathogenic organisms were detected. Conclusion Our results demonstrate that prolonged pre-analytical time does not lead to false-negative blood culture results. The patients’ diagnoses were not changed, therefore, the purchase of additional blood culture instruments was not necessary. However, transportation time from the patient floors to the main microbiology lab needs to be improved to meet the recommended 2 hours pre-analytical time.

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Education of medical personnel optimizes filling volume of blood culture bottles without negatively affecting microbiology testing

BMC Health Services Research ◽

10.1186/s12913-020-05959-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Katrin Steiner ◽

Joanna Baron-Stefaniak ◽

Alexander M. Hirschl ◽

Wolfgang Barousch ◽

Birgit Willinger ◽

...

Keyword(s):

Risk Factor ◽

Blood Culture ◽

Educational Intervention ◽

Medical Personnel ◽

Sample Volume ◽

Blood Cultures ◽

Adverse Outcomes ◽

Filling Volume ◽

Aerobic And Anaerobic ◽

Blood Volumes

Abstract Background Anemia is a risk factor for adverse outcomes, which can be aggravated by unnecessary phlebotomies. In blood culture testing, up to 30 ml of blood can be withdrawn per sample, even though most manufacturers recommend blood volumes of 10 ml or less. After assessing the filling volume of blood culture bottles at our institution, we investigated whether an educational intervention could optimize filling volume of blood culture bottles without negatively affecting microbiology testing. Methods We weighed 10,147 blood cultures before and 11,806 blood cultures after a six-month educational intervention, during which employees were trained regarding correct filling volume via lectures, handouts, emails, and posters placed at strategic places. Results Before the educational intervention, only 31% of aerobic and 34% of anaerobic blood cultures were filled correctly with 5–10 ml of blood. The educational intervention increased the percentage of correctly filled bottles to 43% (P < 0.001) for both aerobic and anaerobic samples without negatively affecting results of microbiologic testing. In addition, sample volume was reduced from 11.0 ± 6.5 to 9.4 ± 5.1 ml (P < 0.001) in aerobic bottles and from 10.1 ± 5.6 to 8.8 ± 4.8 ml (P < 0.001) in anaerobic bottles. Conclusion Education of medical personnel is a simple and effective way to reduce iatrogenic blood loss and possibly moderate the extent of phlebotomy-induced anemia.

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

Scientific Reports ◽

10.1038/s41598-021-00498-x ◽

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.

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Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children

Journal of Pediatric Intensive Care ◽

10.1055/s-0038-1676993 ◽

2019 ◽

Vol 08 (03) ◽

pp. 144-147

Author(s):

Christine Anh-Thu Tran ◽

Jenna Verena Zschaebitz ◽

Michael Campbell Spaeder

Keyword(s):

Decision Making ◽

Blood Culture ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Critically Ill ◽

Clinical Status ◽

Blood Cultures ◽

Systemic Inflammatory Response ◽

Critically Ill Children ◽

Culture Acquisition

AbstractBlood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.

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118. Eliminating Blood Culture Contamination with an Initial-specimen Diversion Device

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.428 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S187-S187

Author(s):

Lucy S Tompkins ◽

Alexandra Madison ◽

Tammy Schaffner ◽

Jenny Tran ◽

Pablito Ang

Keyword(s):

Health Care ◽

Blood Culture ◽

Nursing Staff ◽

False Positive ◽

Blood Cultures ◽

Traditional Methods ◽

Standard Methods ◽

Candida Sp ◽

Initial Specimen ◽

Skin Flora

Abstract Background Blood samples obtained via traditional venipuncture can become contaminated by superficial and deeply embedded skin flora. We evaluated the hospital-wide use of an initial-specimen diversion device (ISDD) designed to shunt these microorganisms away from the culture bottle to reduce blood culture contamination (BCC) and sequelae: false-positive central line-associated bloodstream infections (CLABSIs), repeat blood culture draws, inappropriate antibiotic usage, increased patient length-of-stay and misdiagnosis. The study aimed to show the proportion of blood cultures containing contaminants drawn by phlebotomy staff using the ISDD versus those drawn using traditional methods. Nursing staff continued to use traditional methods to draw blood cultures in the emergency department (ED) and from inpatients. Methods Over a four-month trial at Stanford Health Care (SHC), 4,462 blood cultures were drawn by phlebotomy staff using the ISDD (Steripath Gen2, Magnolia Medical Technologies) in the ED and from inpatients; 922 blood cultures were obtained by phlebotomy staff using standard methods. Additionally, 1,413 blood cultures were drawn by nursing staff using standard methods. The number of matched sets (2 bottles [aerobic/anaerobic] plus 2 bottles [aerobic/anaerobic], with total volume 40 ml) obtained through traditional methods and by the ISDD were recorded. Contaminants were defined by the National Healthcare Safety Network (NHSN). In addition, sets in which 1 out of 4 bottles contained vancomycin-resistant Enterococcus (VRE) or Candida sp. were also recorded, even though these are not considered contaminants by the NHSN. Results Of 4,462 blood cultures obtained using the ISDD there were zero contaminants found (BCC rate 0%) versus 29 contaminated sets using traditional methods (BCC rate 3.15%). Twenty-eight contaminants were observed from nursing staff blood culture draws (BCC rate 1.98%). Zero false-positive CLABSIs were associated with use of the ISDD for the trial period. No matched sets containing 1 of 4 bottles with VRE or Candida sp. were observed. Table Stanford Health Care blood culture collection methods and contamination events (March 15, 2019 - July 21, 2019) Conclusion The trial results encourage adoption of the ISDD as standard practice for blood culture at SHC. Disclosures All Authors: No reported disclosures

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Risk factors and clinical outcomes associated with blood culture contamination

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.111 ◽

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.

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Delayed treatment of bacteremia during the COVID-19 pandemic

Diagnosis ◽

10.1515/dx-2020-0114 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Taiju Miyagami ◽

Yuki Uehara ◽

Taku Harada ◽

Takashi Watari ◽

Taro Shimizu ◽

...

Keyword(s):

Blood Culture ◽

Delayed Diagnosis ◽

Chest Ct ◽

Blood Cultures ◽

Emergency Unit ◽

Medical Providers ◽

Delayed Treatment ◽

Clinical Measures ◽

Primary Measure ◽

Antimicrobial Administration

Abstract Objectives Coronavirus disease (COVID-19) blindness, that is, the excessive consideration of the disease in diagnosis, has reportedly led to delayed diagnosis of some diseases. We compared several clinical measures between patients admitted for bacteremia during the two months of the COVID-19 pandemic and those admitted during the same period in 2019. We hypothesized that the pandemic has led to delayed treatment of bacteremia. Methods This retrospective observational study compared several measures undertaken for patients who visited the emergency unit in two hospitals between March 1 and May 31, 2020, during the COVID-19 pandemic and whose blood cultures tested positive for bacteremia with those for corresponding patients treated during the same period in 2019. The primary measure was time from consultation to blood culture/antimicrobials. Results We included 29 eligible patients from 2020 and 26 from 2019. In 2020, the time from consultation to antimicrobial administration was significantly longer than in 2019 (mean [range], 222 [145–309] min vs. 139 [102–179] min, p=0.002). The frequency of chest computed tomography (CT) was significantly higher in 2020 (96.6 vs. 73.1%, p=0.021). Significant differences were not observed in the time to blood culture or chest CT preceding the blood culture between the two periods. Conclusions Our findings suggested that due to the COVID-19 epidemic/pandemic, focusing on the exclusion of its infection using CT scans leads to an overall delay in the diagnosis and treatment of bacteremia. Medical providers must be aware of COVID-19 blindness and evaluate patients objectively based on rational criteria and take appropriate action.

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