Evaluation of the Safety and Performance of Blood Culture Practices Using BD Safety-Lok™ Blood Collection Sets in the Emergency Room

AbstractOptimisation of microbiological diagnostics in primarily sterile body fluids is required. Our objective was to apply EUCAST’s RAST on primarily sterile body fluids in blood culture bottles with total lab automation (TLA) and to compare results to our reference method Vitek2 in order to report susceptibility results earlier. Positive blood culture bottles (BACTEC™ Aerobic/Anaerobic/PEDS) inoculated with primarily sterile body fluids were semi-automatically subcultured onto Columbia 5% SB agar, chocolate agar, MacConkey agar, Schaedler/KV agar and Mueller-Hinton agar. On latter, cefoxitin, ampicillin, vancomycin, piperacillin/tazobactam, meropenem and ciprofloxacin were added. After 6 h, subcultures and RAST were imaged and MALDI-TOF MS was performed. Zone sizes were digitally measured and interpreted following RAST breakpoints for blood cultures. MIC values were determined using Vitek2 panels. During a 1-year period, 197 Staphylococcus aureus, 91 Enterococcus spp., 38 Escherichia coli, 11 Klebsiella pneumoniae and 8 Pseudomonas aeruginosa were found. Categorical agreement between RAST and MIC was 96.5%. Comparison showed no very major errors, 2/7 (28.6%) and 1/7 (14.3%) of major errors for P. aeruginosa and meropenem and ciprofloxacin, 1/9 (11.1%) for K. pneumoniae and ciprofloxacin, 4/69 (7.0%) and 3/43 (5.8%) for Enterococcus spp. and vancomycin and ampicillin, respectively. Minor errors for P. aeruginosa and meropenem (1/8; 12.8%) and for E. coli and ciprofloxacin (2/29; 6.5%) were found. 30/550 RAST measurements were within area of technical uncertainty. RAST is applicable and performs well for primarily sterile body fluids in blood culture bottles, partially better than blood-based RAST. Official EUCAST evaluation is needed.

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

Journal of Clinical Pathology ◽

10.1136/jcp.2007.047647 ◽

2007 ◽

Vol 61 (4) ◽

pp. 509-513 ◽

Cited By ~ 20

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.

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Performance Improvement and Performance Dysfunction: An Empirical Examination of Impacts of the Emergency Room Wait-Time Target in the English National Health Service

SSRN Electronic Journal ◽

10.2139/ssrn.976553 ◽

2007 ◽

Cited By ~ 4

Author(s):

Steven Kelman ◽

John N. Friedman

Keyword(s):

National Health Service ◽

Health Service ◽

Emergency Room ◽

Performance Improvement ◽

National Health ◽

Wait Time ◽

Empirical Examination ◽

And Performance ◽

English National Health ◽

English National Health Service

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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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Thrombin-Accelerated Quick Clotting Serum Tubes: An Evaluation with 22 Common Biochemical Analytes

Advances in Hematology ◽

10.1155/2013/769479 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Wai-Yoong Ng ◽

Chin-Pin Yeo

Keyword(s):

Test Performance ◽

High Volume ◽

Blood Collection ◽

Test Accuracy ◽

Significant Deterioration ◽

Whole Process ◽

Clinical Laboratories ◽

And Performance ◽

Serum Storage ◽

Time Required

Clot activator serum tubes have significantly improved turnaround times for result reporting compared to plain tubes. With increasing workload and service performance expectations confronting clinical laboratories with high-volume testing and with particular emphasis on critical analytes, attention has focussed on preanalytical variables that can be improved. We carried out a field study on the test performance of BD vacutainer rapid serum tubes (RSTs) compared to current institutional issued BD vacutainer serum separator tubes (SSTs) in its test result comparability, clotting time, and stability on serum storage. Data from the study population (n=160) of patients attending outpatient clinics and healthy subjects showed that results for renal, liver, lipids, cardiac, thyroid, and prostate biochemical markers were comparable between RSTs and SSTs. Clotting times of the RSTs were verified to be quick with a median time of 2.05 min. Analyte stability on serum storage at 4°C showed no statistically significant deterioration except for bicarbonate, electrolytes, and albumin over a period of 4 days. In conclusion, RSTs offered savings in the time required for the clotting process of serum specimens. This should translate to further trimming of the whole process from blood collection to result reporting without too much sacrifice on test accuracy and performance compared to the current widely used SSTs in most clinical laboratories.

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Development and performance of a fully automated method for assay of C-reactive protein in the aca discrete clinical analyzer.

Clinical Chemistry ◽

10.1093/clinchem/34.8.1646 ◽

1988 ◽

Vol 34 (8) ◽

pp. 1646-1649 ◽

Cited By ~ 6

Author(s):

M W Schwartz ◽

R S Schifreen ◽

E Gorman ◽

P M Tuhy ◽

J Bienvenu ◽

...

Keyword(s):

Emergency Room ◽

Rheumatoid Factor ◽

Total Bilirubin ◽

Reference Interval ◽

C Reactive Protein ◽

Reactive Protein ◽

Automated Method ◽

Quantitative Immunoassay ◽

And Performance ◽

Turbidimetric Immunoassay

Abstract A quantitative immunoassay for C-reactive protein (CRP) has been developed for use in the Du Pont aca discrete clinical analyzer. Particle-enhanced turbidimetric immunoassay (PE-TIA) technology is used. The method has a CV of less than 10% in the range 2 to 120 mg/L. Neither hemolyzed samples (Hb less than 5 g/L), icteric samples (total bilirubin less than 300 mg/L), lipemic samples (triglyceride less than 15 g/L), nor some commonly used drugs interfere. Dithioerythritol is used to eliminate interference from rheumatoid factor. Good correlation was seen when the Du Pont CRP method was compared with the Beckman ICS, Syva EMIT, TDx, and Behring methods for CRP. The normal reference interval is 0 to 9 mg/L. The method, which is fully automated, is fast, requires only a few microliters of serum, and is well suited to emergency-room requirements.

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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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