G-control Charts for Contamination Rates of Blood Cultures in a University Hospital

Objective: To determine blood culture contamination rates, and display with a g-chart.Materials and Methods: The medical records of patients, from whom blood cultures were obtained in a university hospital, during January and December 2019 were retrieved and reviewed for contamination. The Center for Disease Control and Prevention (CDC) criteria were used to classify the blood culture results. The contamination rates were illustrated with a g-chart.Results: We identified 331 false-positive blood cultures, among 32,961 cultured specimens; yielding a contamination rate of 1.0% (95%CI = 0.9% – 1.1%). The highest contamination events occurred in the Emergency department (49.2%), Pediatric ICU (5.2%) and Neonatal ICU (4.8%), respectively. The most common commensal bacterial genus were Staphylococcus coagulase negative (67.1%), Bacillus spp. (10.2%) and Corynebacterium spp. (7.6%), correspondingly. The g-charts could identify 14 abnormal variations, in 41 locations.Conclusion: The contamination rates found were within ranges of other reports. G-charts are simple to construct, easy to interpret and sensitive for detection of real time epidemics.

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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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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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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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Three Clusters of Bacillus Pseudobacteremia Related to a Radiometric Blood Culture Analyzer

Infection Control ◽

10.1017/s0195941700058975 ◽

1984 ◽

Vol 5 (2) ◽

pp. 71-74 ◽

Cited By ~ 20

Author(s):

Inge Gurevich ◽

Patricia Tafuro ◽

Sharon P. Krystofiak ◽

Robert D. Kalter ◽

Burke A. Cunha

Keyword(s):

Blood Culture ◽

Clinical Signs ◽

Blood Cultures ◽

Bacillus Species ◽

Common Source ◽

Air Conditioner ◽

Close Proximity ◽

Bacillus Spp ◽

Multiple Blood ◽

Bacillus Spores

AbstractDuring a ten-month period from September 1981 to July 1982 three episodes of pseudobacteremia due to Bacillus species occurred at this 550-bed institution. The first involved eight isolates, the second 11, and the third seven isolates of the organism, all with the same antibiogram.The patients involved did not exhibit clinical signs of septicemia, and in only one case was more than one specimen per patient positive when multiple blood samples were obtained. Occasional blood cultures of Bacillus species identified in between clusters revealed a different antibiogram.Extensive epidemiologic investigation of patient locations, phlebotomists, and time of cultures yielded no common source. Components involved in the transport and processing of blood cultures, including the radiometric blood culture processor, were also sampled but without recovery of the organism. After the last episode, a layer of dust was noted inside the machine, and culture of this dust grew Bacillus spp. with the same antibiogram as those found in the blood cultures. The filter from an air conditioning unit in close proximity to the machine grew several species of Bacillus.It is presumed that Bacillus spores in the dust were introduced into the blood culture bottles following the heat sterilization of the gas sampling (inoculation/removal) needles.Modification of the cover of the machine was undertaken to prevent access of dust bearing microbes to the inside of the machine. In addition, maintenance now includes regular disinfection/cleaning of the “floor” of the machine, and more frequent changes of the air conditioner filter.

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Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

10.51429/ejmm30111 ◽

2021 ◽

Vol 30 (1) ◽

pp. 87-91

Author(s):

Tamer Mohamed ◽

Ashraf A Askar ◽

Jamila Chahed

Keyword(s):

Quality Improvement ◽

Blood Culture ◽

Armed Forces ◽

Blood Cultures ◽

Quality Improvement Project ◽

Contamination Rate ◽

Improvement Project ◽

Culture Test ◽

Negative Results ◽

Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

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Blood Culture Contamination in the Clinical Microbiology Laboratory of a Teaching Hospital

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz125.013 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S133-S133

Author(s):

Kemin Xu ◽

Sarwat Gilani ◽

Hank Wang ◽

John Fallon

Keyword(s):

Blood Culture ◽

Teaching Hospital ◽

Clinical Microbiology ◽

Diagnostic Errors ◽

Blood Cultures ◽

Bacillus Species ◽

Contamination Rate ◽

Clinical Microbiology Laboratory ◽

Current Guideline ◽

Tertiary Teaching

Abstract Objectives Blood culture is one of the most important tests performed in clinical microbiology laboratories. However, blood culture contamination remains a problematic cause of diagnostic errors for laboratory diagnosis and patient management. This aim of this study was to determine blood culture contamination rates and tendency at Westchester Medical Center (WMC), a tertiary teaching hospital in suburban New York City. Methods All blood culture tests at WMC received from January 2017 to December 2018, as well as some historical data from 2007 to 2014, were retrospectively retrieved. Blood culture contamination rates were determined according to the laboratory’s predefined criteria. Results From 2007 to 2014, a total of 209,750 blood cultures were performed with an average contamination rate of 1.6% (ranging from 0.4% to 3.5% monthly). The total numbers of blood cultures performed in 2017 and 2018 were 27,863 and 28,047, respectively. The overall positive rate of blood culture was 6.8% in 2017 and 7.6% in 2018. The contamination rate of blood culture was 0.6% in 2017 and 0.9% in 2018 with very few variations among different months of the year, which was significantly lower than that of the national benchmark (~2.5%) on blood culture contamination. The majority of contaminants were Staphylococcus epidermidis, accounting for 87% of source contamination, followed by Corynebacterium species (5.5%), Bacillus species and Micrococcus species (3.5% each), and Propionibacterium species (0.5%). Conclusion Adherence to current guideline on appropriate blood collection techniques and monthly monitoring and timely feedback to phlebotomists should be continued to keep a low contamination rate for blood culture, which is not only from the perspective of individual patient care but also from the standpoint of hospital epidemiology and public health.

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Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Journal of Clinical Microbiology ◽

10.1128/jcm.01457-16 ◽

2016 ◽

Vol 54 (12) ◽

pp. 3007-3009 ◽

Cited By ~ 6

Author(s):

Elizabeth Story-Roller ◽

Melvin P. Weinstein

Keyword(s):

Blood Culture ◽

Crossover Study ◽

Clinical Care ◽

Bloodstream Infections ◽

Antibiotic Use ◽

University Hospital ◽

Contamination Rate ◽

Nursing Unit ◽

Skin Antisepsis ◽

Randomized Crossover Study

Blood cultures (BCs) are the standard method for diagnosis of bloodstream infections (BSIs). However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, potentially resulting in unnecessary antibiotic use and excessive therapy costs. Several studies have compared various skin antisepsis agents without a clear consensus as to which agent is most effective in reducing contamination. A prospective, randomized crossover study directly comparing blood culture contamination rates using chlorhexidine versus iodine tincture for skin antisepsis was performed at Robert Wood Johnson University Hospital (RWJUH). Eight nursing units at RWJUH were provided with blood culture kits containing either chlorhexidine (CH) or iodine tincture (IT) for skin antisepsis prior to all blood culture venipunctures, which were obtained by nurses or clinical care technicians. At quarterly intervals, the antiseptic agent used on each nursing unit was switched. Analyses of positive BCs were performed to distinguish true BSIs from contaminants. Of the 6,095 total BC sets obtained from the participating nursing units, 667 (10.94%) were positive and 238 (3.90%) were judged by the investigators to be contaminated. Of the 3,130 BCs obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of 2,965 BCs obtained using CH, 327 (11.03%) were positive and 115 (3.88%) were contaminated. The rates of contaminated BCs were not statistically significant between the two antiseptic agents (P= 1.0). We conclude that CH and IT are equivalent agents for blood culture skin antisepsis.

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Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

Kansas Journal of Medicine ◽

10.17161/kjm.vol1413804 ◽

2021 ◽

Vol 14 ◽

pp. 73-76

Author(s):

Blake Buzard ◽

Patrick Evans ◽

Todd Schroeder

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Blood Culture ◽

Blood Cultures ◽

Contamination Rate ◽

Total Hospital Cost ◽

Initial Specimen ◽

Significant Difference ◽

Secondary Outcomes ◽

The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department. Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained. Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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660. Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.857 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S432-S432

Author(s):

Alexander G Hosse

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Nursing Staff ◽

Blood Cultures ◽

Hospital Length Of Stay ◽

Contamination Rate ◽

Culture Collections ◽

Total Blood ◽

Primary Driver ◽

Inpatient Units

Abstract Background Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic. Methods Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units. Results The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units. Figure 1. Comparison of contamination rates in the ED vs the inpatient units from all campuses from September 2019 through September 2020. The blue line represents the hospital goal of 2.25% contamination rate. Solid lines represent total contamination rates including COVID isolation units whereas dotted lines represent units excluding COVID isolation units. Figure 2. Comparison of the non-COVID vs COVID isolation units in the emergency department and inpatient units. The red line represents the hospital goal of less than 2.25% for blood culture contamination rate. Table of Contaminants vs. Total Collected Blood Cultures in Each Unit by Month Figure 3. Raw data from Figure 2. Total blood culture contaminations from each unit by month compared to total blood culture collections from each unit by month. Conclusion Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during. Disclosures All Authors: No reported disclosures

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Health vigilance concerning Acinetobacter baumannii bacteremia at the mohammed VI university hospital of oujda (morocco): epidemiological profile and antibiotic resistance

E3S Web of Conferences ◽

10.1051/e3sconf/202131901003 ◽

2021 ◽

Vol 319 ◽

pp. 01003

Author(s):

Loubna Yacoubi ◽

Soumia Farih ◽

Noussaiba Benhamza ◽

Abderazzak Seddari ◽

Adil maleb

Keyword(s):

Antibiotic Resistance ◽

Blood Cultures ◽

University Hospital ◽

Microbiology Laboratory ◽

Prevention Measures ◽

Control And Prevention ◽

Epidemiological Profile ◽

Healthcare Associated ◽

Resistance Rates ◽

Contaminated Blood

The objective of this work is to determine the epidemiological profile of Acinetobacter b aumannii (A.baumannii ) bacteremia in the microbiology laboratory of CHU Mohammed VI of Oujda and its antibiotic resistance rates. This is a retrospective and descriptive study of 27 months from June 24, 2016to September 19, 2018 including all positive blood cultures processed in the microbiology laboratory in accordance with REMIC (reference in medical microbiology)and EUCAST(European Committee on Antimicrobial Susceptibility Testing). Contaminated blood cultures were excluded. As results we collected 863 positive blood cultures, A. baumannii accounted for 7.41% (n = 64). 67% (n =43) of the strains were isolated from patients hospitalized in intensive care (adults, children and newborns). The two main risk factors described in patients with our series were wearing of intravascular device in 55% (n=35) Immunosuppression in 22% n=14). A. baumannii bacteremia was associated with care in 37.5% (n=24). 75% (n=48) of A. baumannii isolates were resistant to carbapenems. No strain of A. baumannii was resistant to colistin. In light of these results strengthening the control and prevention measures for healthcare associated infections would be the most reliable way to limit the spread of A. baumannii in our establishment.

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