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

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 In blood culture testing, up to 30 ml of blood can be withdrawn per sample, even though most manufacturers recommend blood volumes of 10 ml or less.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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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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Effect of Clinically Meaningful Antibiotic Concentrations on Recovery of Escherichia coli and Klebsiella pneumoniae Isolates from Anaerobic Blood Culture Bottles with and without Antibiotic Binding Resins

Journal of Clinical Microbiology ◽

10.1128/jcm.01344-19 ◽

2019 ◽

Vol 57 (12) ◽

Cited By ~ 2

Author(s):

Iris H. Chen ◽

David P. Nicolau ◽

Joseph L. Kuti

Keyword(s):

Escherichia Coli ◽

Blood Culture ◽

Klebsiella Pneumoniae ◽

Blood Cultures ◽

Content Type ◽

E Coli ◽

Detection Systems ◽

Affect Detection ◽

Trough Concentrations ◽

Aerobic And Anaerobic

ABSTRACT Blood cultures are routinely collected in pairs of aerobic and anaerobic bottles. Artificial sterilization of Gram-negative bacteria in aerobic bottles containing clinically meaningful antibiotic concentrations has previously been observed. This study assessed recovery from anaerobic bottles with and without antibiotic binding resins. We studied the recovery of Escherichia coli and Klebsiella pneumoniae when exposed to meropenem, imipenem, cefepime, cefazolin, levofloxacin, and piperacillin-tazobactam in resin-containing BacT/Alert FN Plus and BD Bactec Plus anaerobic/F bottles as well as resin-free BacT/Alert SN and BD Bactec standard anaerobic bottles. Bottles were inoculated with bacteria and whole blood containing peak, midpoint, or trough concentrations and incubated for up to 120 hours in their respective detection systems. In E. coli resin-containing bottles, recovery was observed in 10/24 (42%), 17/24 (71%), and 18/24 (75%) (P = 0.034) of those exposed to peak, midpoint, and trough concentrations, respectively. In K. pneumoniae resin-containing bottles, recovery was observed in 8/16 (50%), 10/16 (63%), and 10/16 (63%) (P = 0.710), respectively. No growth was detected in bottles containing cefepime regardless of concentration, while recovery was observed in the presence of all concentrations of cefazolin and piperacillin-tazobactam. Recovery in bottles with meropenem and imipenem was more frequently observed in BacT/Alert FN Plus bottles compared with Bactec Plus bottles. Resin-free bottles demonstrated significantly lower recovery than bottles containing binding resin. Clinical concentrations of certain antibiotics can adversely affect detection of E. coli and K. pneumoniae in anaerobic blood culture bottles. Obtaining blood cultures immediately before a dose and utilizing resin-containing anaerobic bottles will maximize the likelihood of recovery.

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Comparison of microorganism detection and time-to-positivity in pediatric and standard media from three major commercial continuously monitored blood culture systems

Journal of Clinical Microbiology ◽

10.1128/jcm.00429-21 ◽

2021 ◽

Author(s):

Melanie L. Yarbrough ◽

Meghan A. Wallace ◽

Carey-Ann D. Burnham

Keyword(s):

Blood Culture ◽

Detection Rate ◽

Culture Media ◽

Blood Cultures ◽

Kingella Kingae ◽

Packed Red Blood Cells ◽

Culture Systems ◽

Time To Positivity ◽

Species Specific ◽

Blood Volumes

New blood culture instrumentation and media formulations have led to improved time-to-positivity (TTP) for positive blood cultures. Data regarding the necessity of pediatric blood culture bottles with contemporary blood culture systems are sparse. We compared performance of three commercial blood culture systems, evaluating impact of blood volumes in standard and pediatric blood culture media across systems. Simulated blood cultures with packed red blood cells and three Gram-positive, four Gram-negative, and one anaerobic organism (final concentrations ranging from 0.5-19 CFU/mL blood) on the VIRTUO, VersaTREK, and Bactec FX were evaluated with FAN Plus, REDOX, and BACTEC Plus media, respectively. For each media/instrument/organism combination 1, 3, 5, and 10 mL blood volumes were evaluated in triplicate. Detection rate was not affected by blood volume. Aerobic organisms that demonstrated variable detection were Kingella kingae, Haemophilus influenzae and Neisseria meningitidis. Bacteroides fragilis was detected in 83%, 100%, and 100% of VIRTUO, VersaTREK, and Bactec anaerobic bottles. Average TTP of standard media for aerobic organisms detected on VIRTUO was decreased compared to VersaTREK (-2.3 h) and Bactec (-4.9 h). Compared to standard media, detection rate and TTP was unchanged on VIRTUO, while TTP was reduced with pediatric media for 2/8 organisms tested on Bactec and 7/8 organisms on VersaTREK, illustrating the potential benefit of pediatric media on VersaTREK or BACTEC when low blood volumes (<5 mL) are collected. These results demonstrate that TTP is decreased on the VIRTUO compared to VersaTREK and Bactec for many microorganisms associated with BSI but may have species-specific limitations.

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Failed Knowledge Retention from Educational Intervention on Anaphylaxis Management Among Medical Personnel

Scholar: Pilot and Validation Studies ◽

10.32778/spvs.71366.2021.16 ◽

2021 ◽

Vol 2 (1) ◽

pp. 11-16

Author(s):

John Johnson ◽

Tina Abraham ◽

Monica Sandhu ◽

Brian P. Peppers ◽

Cathy Knorzer ◽

...

Keyword(s):

Educational Intervention ◽

Hospital Setting ◽

Improve Patient Care ◽

Medical Personnel ◽

Knowledge Retention ◽

Adverse Outcomes ◽

Healthcare Personnel ◽

Multiple Choice Questions ◽

University Hospitals ◽

Initial Questionnaire

Abstract Background: Anaphylaxis is a life-threatening allergic reaction that is often inadequately treated in the hospital setting, leading to adverse outcomes. We hypothesize that a brief educational intervention will enhance knowledge of community-based medical professionals evaluated by pre- and post-questionnaires, leading to improved recognition and management of anaphylaxis. Methods: An initial questionnaire consisting of eight multiple-choice questions and two fill in response pertaining to anaphylaxis identification, management, and treatment was completed by 189 University Hospitals Regional Hospitals personnel, including faculty, nurses, student, residents, and Emergency Medical Services (EMS). The participants were then offered an educational intervention, including a 10-slide, 20-minute PowerPoint presentation on anaphylaxis, and review of the pre-educational intervention questionnaire responses, followed by a post-educational intervention questionnaire similar to the initial questionnaire. Seventy-seven participants completed the same questionnaire at a six-month follow-up to assess retention. Results: Participant scores improved from 62% to 94%, from the initial questionnaire to the immediate post- educational intervention questionnaire. The six-month post-educational intervention questionnaire revealed a return to near baseline (65%) medical knowledge regarding anaphylaxis Conclusion: Healthcare personnel demonstrate a knowledge deficit of identification and management of anaphylaxis. In the short-term, a brief, educational intervention did improve knowledge of anaphylaxis (p<0.00001). However, in the long-term, this educational intervention did not improve knowledge retention about anaphylaxis (p=0.52218). We received approval for and implemented an anaphylaxis order set in the electronic medical record (EMR) at University Hospitals, in effort to improve patient care.

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Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children’s Hospital

Clinical Pediatrics ◽

10.1177/0009922818778042 ◽

2018 ◽

Vol 57 (11) ◽

pp. 1310-1317 ◽

Cited By ~ 6

Author(s):

Freya C. Harewood ◽

Nigel Curtis ◽

Andrew J. Daley ◽

Penelope A. Bryant ◽

Amanda Gwee ◽

...

Keyword(s):

Blood Culture ◽

Antibiotic Therapy ◽

Blood Volume ◽

Educational Intervention ◽

Blood Cultures ◽

Culture Result ◽

Children's Hospital ◽

Before And After ◽

Low Volume ◽

The Impact

The volume of blood sampled for culture critically influences the results. This study aimed to determine (1) the volume of blood submitted for culture, (2) the proportion of blood cultures with adequate volume, (3) whether measured improvement from a previous educational intervention had been sustained, and (4) the impact of blood volume on culture result. The volume of blood submitted for cultures was determined over a 13-month period by weighing bottles before and after collection and before and after an educational intervention. The volume of blood submitted in 5127 culture bottles were measured. Fewer than 50% of all cultures were deemed adequate. A significant pathogen was isolated in 4.7% of blood cultures, and low-volume cultures were more likely to yield contaminant isolates (47/2422 [1.9%] vs 22/2705 [0.8%], P = .0005). Subsequently, the higher rate of contaminant isolates from low-volume cultures may affect selection and rationalization of antibiotic therapy.

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Controlled Clinical Comparison of bioMérieux VITAL and BACTEC NR-660 Blood Culture Systems for Detection of Bacteremia and Fungemia in Adults

Journal of Clinical Microbiology ◽

10.1128/jcm.37.6.1709-1713.1999 ◽

1999 ◽

Vol 37 (6) ◽

pp. 1709-1713 ◽

Cited By ~ 6

Author(s):

Michael L. Wilson ◽

Stanley Mirrett ◽

L. Clifford McDonald ◽

Melvin P. Weinstein ◽

Jose Fune ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Blood Cultures ◽

Adult Patients ◽

Pathogenic Microorganisms ◽

Culture Systems ◽

Clinical Comparison ◽

Anaerobic Bottle ◽

Bactec System ◽

Aerobic And Anaerobic

A total of 9,446 blood cultures were collected from adult patients at three university-affiliated hospitals. Of these, 8,943 cultures were received with both aerobic bottles filled adequately; 885 yielded 1,016 microorganisms, including 622 isolates (61%) that were the cause of sepsis, 337 isolates (33%) that were contaminants, and 57 isolates (6%) that were indeterminate as the cause of sepsis. With the exception of Staphylococcus aureus, which was recovered more often from VITAL aerobic bottles, more pathogenic microorganisms were recovered from BACTEC NR6 (aerobic) bottles than from VITAL aerobic bottles. Growth of pathogenic microorganisms was detected earlier in VITAL aerobic bottles. A total of 8,647 blood cultures were received with both anaerobic bottles filled adequately; 655 yielded 740 microorganisms, including 486 isolates (66%) that were the cause of sepsis, 215 isolates (29%) that were contaminants, and 39 isolates (6%) that were indeterminate as the cause of sepsis. More pathogenic microorganisms were recovered from VITAL anaerobic bottles than from BACTEC NR7 (anaerobic) bottles. Growth of pathogenic microorganisms was detected earlier in VITAL anaerobic bottles. In 8,500 sets all four bottles were received adequately filled. When paired aerobic and anaerobic bottle sets (systems) were compared, more pathogenic microorganisms (again with the exception of S. aureus) were recovered from the BACTEC system. For the 304 septic episodes (253 unimicrobial and 51 polymicrobial), significantly more were detected by the BACTEC system. We conclude that VITAL requires modification to improve recovery of pathogenic microorganisms to make it competitive with other commercially available blood culture systems.

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Controlled Clinical Laboratory Comparison of Two Supplemented Aerobic and Anaerobic Media Used in Automated Blood Culture Systems To Detect Bloodstream Infections

Journal of Clinical Microbiology ◽

10.1128/jcm.36.3.657-661.1998 ◽

1998 ◽

Vol 36 (3) ◽

pp. 657-661 ◽

Cited By ~ 43

Author(s):

R. Ziegler ◽

I. Johnscher ◽

P. Martus ◽

D. Lenhardt ◽

H.-M. Just

Keyword(s):

Blood Culture ◽

Clinical Laboratory ◽

False Positive Rate ◽

False Negative ◽

Bloodstream Infections ◽

Blood Cultures ◽

Negative Results ◽

Two Systems ◽

Time To Detection ◽

Aerobic And Anaerobic

A 20-ml blood sample was collected from adult patients with suspected bloodstream infections and distributed equally into the four volume-controlled bottles of a blood culture set consisting of aerobic and anaerobic BACTEC Plus/F bottles and aerobic and anaerobic BacT/Alert FAN bottles. All bottles were incubated in their respective instruments for a standard 5-day protocol or until the instruments signalled positivity. Samples in all bottles with negative results by these instruments were terminally subcultured. A total of 8,390 blood culture sets were obtained during the study period, of which 4,402 (52.5%) met the study criteria. Of these, 946 (21.5%) were positive either by instrument signal or by additional terminal subculture of all negative bottles and yielded growth of microorganisms. Five hundred eighty-nine (13.4%) blood culture sets were considered to have recovered 663 clinically significant organisms. When both the BACTEC and the BacT/Alert systems were used, 465 positive sets were detected; BACTEC alone detected 52 positive sets and BacT/Alert alone detected 72 (P = 0.09). No differences were found between the two systems in microbial recovery rate from blood cultures obtained from patients on antibiotic therapy. Significantly more members of the family Enterobacteriaceae (P < 0.01) were detected from patients without antimicrobial therapy by BacT/Alert than by BACTEC. The false-negative rates were 0.20% for BACTEC and 0.32% for BacT/Alert. A significantly higher false-positive rate was found for BACTEC (P < 0.0001). Both systems were comparable for the time to detection of microorganisms. However, gram-positive bacteria were detected faster by BACTEC andEnterobacteriaceae were detected faster on average by BacT/Alert. We concluded that both systems are comparable in their abilities to recover aerobic and anaerobic organisms from blood cultures and a terminal subculture might not be necessary for either of the two systems. The increased positivity rate when using an anaerobic bottle in a two-bottle blood culture set is due to the additional blood volume rather than to the use of an anaerobic medium.

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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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Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

BMC Infectious Diseases ◽

10.1186/s12879-021-06391-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sandra Chamat-Hedemand ◽

Niels Eske Bruun ◽

Lauge Østergaard ◽

Magnus Arpi ◽

Emil Fosbøl ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Blood Culture ◽

Positive Blood Culture ◽

Bloodstream Infections ◽

Low Risk ◽

Moderate Risk ◽

Streptococcal Species ◽

Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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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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