Reducing our contamination rates would directly coincide with the system and GCMC's lean strategic planning goals of reducing infections and length of stays. In 2015, Houston Methodist Willowbrook Emergency Department blood culture contamination rate was 6.23% due to lack of training and inconsistent technique. blood culture contamination in the emergency department: Sterile collection kits and phlebotomy teams. 1 17 Manual diversion of the initial volume of blood • Peer-reviewed published data has shown only modest unsustainable reductions in contamination • Lowest published contamination rate achieved is 2.0%1 (best case controlled clinical study scenario) 1Zimmerman, et al. conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually. Yes, according to literature, 20% to 50% are likely false positives.¹ Blood culture contamination rates should not exceed the recommended 3% of all blood culture collections according to the American Society for Microbiology (ASM) and the Clinical Laboratory Standards Institute (CLSI).¹. Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. Blood culture contamination rates decreased from 3.39% to 2.6%. It is therefore important to identify risk factors associated with blood culture contamination in EDs. Both RNs and EDTs were also required to participate in an annual refresher program for proper BC collection. 1, Hospital A). Hospital leaders need to be aware of the national movement toward a new blood culture contamination benchmark of 1%. . 2 The negative consequences of blood culture contamination on . Blood cultures are commonly ordered in the emergency department (ED) setting to evaluate for bacteremia. Modification of Blood Test Draw Order to Reduce Blood Culture Contamination.Clin Infect Dis. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. INTRODUCTION. Current evidence suggests that the emergency department (ED) often has blood culture contamination (BCC) rates above the recommended 3%, contributing to increased hospital length of stay, unnecessary or inappropriate antimicrobial treatment, and increased economic burden. Why Do We Care? They found that after the diversion protocol was introduced, the contamination rate in the emergency department dropped from 2.92 percent to 1.95 percent, while the inpatient contamination rate dropped from 1.82 percent to 1.31 percent. Blood culture contamination rates in emergency departments (ED) . the aim of reducing the blood culture contamination rate in our ED to less than 3% and sustaining this low rate. 1 However, false positive blood cultures due to specimen contamination with skin bacteria are common and lead to patient morbidity and escalation of healthcare costs. Same-site and single-set collection issues were . The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. BACKGROUND AND OBJECTIVE:. Clinical Microbiology Reviews, 19(4), 788-802. One method shown to be effective in reducing contamination is initial blood specimen diversion during collection. . collection system in reducing blood culture contamination rates. Clinical Microbiology Reviews, 19(4), 788-802. 1 However, false positive blood cultures due to specimen contamination with skin bacteria are a common problem that leads to unnecessary patient morbidity, increased hospital costs, and health care system inefficiencies. •The contamination rate standard of less than 3% has been established by the American society of microbiology •Many studies have shown a range of expense to an organization related to blood culture contamination of $4000 to greater than $10000 per patient . Methods: The standard blood culture sampling kit was supplemented with an instruction sheet on the optimal method for drawing blood cultures and a large 62% ethyl alcohol impregnated wipe. A financial measure estimated the savings in charges between the observed and expected contaminants in PDSA3. . The aim of this review is to identify effective . Quality Initiative: Reducing Blood Culture Bottle Contamination Rates Simple strategies can improve quality outcomes Mark Book, BS, RN, CEN, Staff Development Instructor Harrisburg Emergency Department, PinnacleHealth System Quality Related Issues: • Blood culture contamination rates were found to be consistently elevated (5 - 6%) on blood The task force included an emergency physician cham- pion, an ED nurse champion, the chief hospital epidemi- ologist, ED administrators, ED nursing leadership, microbiology laboratory personnel, and infection control personnel. Methods that should be employed to decreased blood culture contamination include the following: Patient selection: Blood cultures should only be . This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. 10 Hall, K. K., & Lyman, J. 2-8 Patients . Contaminant blood cultures and resource utilization. Magnolia Medical Technologies, Inc., inventors of Steripath®, the only FDA 510(k)-cleared device platform specifically indicated to reduce blood culture contamination for sepsis testing accuracy . cost of $1.4 to $1.8 million. (Fig. The ED BC contamination rate spike . Bates DW, Goldman L, Lee TH. 5, 6 Recently, Zimmerman et al 5 suggested the use of a departmental report card to monitor the blood . 26 27 Faced with these contamination rates clinicians cannot be sufficiently confident in initial positive BC results to alter patient management. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED. Results: Over a 6-month period, a reduction in the BCC rate at the emergency department (ED) of the University Hospital reached 1.5% compared with the baseline at 4.0%. The balancing measure was the proportion of pathogenic bacteremia cases at ED return visits before and after PDSA3 implementation. 2-7 These contaminated blood cultures have significant negative consequences for individual patients . From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for . Current evidence suggests that the emergency department (ED) often has blood culture contamination (BCC) rates above the recommended 3%, contributing to increased hospital length of stay, unnecessary or inappropriate antimicrobial treatment, and increased economic burden. Hence, it is imperative that the rate of contamination is minimized in order for blood culture testing to be considered cost-effective. Methodology/Principal Findings A prospectively observational study in a university-affiliated hospital were conducted between August . PMID: 22727270. . All PDSA cycle data on the project measures were extracted from the lab information system to be analyzed and presented on run and control charts. EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination . The study objective was to develop and . Reducing the Rate of Blood Culture Contamination in the Emergency Department of a University Teaching Hospital. The College of American Pathologist set a national benchmark for blood culture contamination rate at 3%. The study objective was to develop and . the . J Emerg Nurs. Ropp, P. (2012, February). Based on the . MeSH terms Blood Culture* Developing a plan that is evidence-based and feasible in the fast paced Emergency Department can . collection system in reducing blood culture contamination rates. OBJECTIVES Blood culture contamination is a common problem in the emergency department . contamination rates in the emergency department. Interventions Interventions to reduce blood culture contamination, including prep kits . 2013;131(1):e292-7. Blood culture contamination rates decreased from 3.39% to 2.6%. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings Abstract Background and objective: Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. Objectives: To reduce the contamination rate of blood cultures taken in the Accident and Emergency (A&E) department. •Blood culture contamination rates in the emergency department regularly exceed the national standard of less than 3%. The blood culture is an essential tool in clinical medicine for detecting bacteremia and guiding antibiotic therapy. Bell, M., et al. Baseline measurement Go to: Baseline measurement Both RNs and EDTs were also required to participate in an annual refresher program for proper BC collection. 10 Hall, K. K., & Lyman, J. Methods Blood-culture results may affect clinical decision making. The commitment from our team was considered the most valuable asset and strategy. 2019; 2Data on file;; 3Tompkins . Discussion: The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. Blood culture collection remains the gold standard to diagnose bacteraemia. T.R., Paul, B.R., Collins, S.P . Journal of Emergency Nursing, 39(5), 459-464. Infect . 1, Issue. Discussion: The total hospital BC contamination rate never rose above the 3% benchmark, which illustrates the importance of tracking ED-specific data. Same-site collection rates decreased from 15.13% to 4.14%. Global Journal on Quality and Safety in Healthcare, Vol. OBJECTIVES: Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. Typical interventions to reduce blood culture contamination, such as ongoing training and education on best practices, cannot address the skin and skin plug contamination and have shown only modest and . Pediatrics. Objectives Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. 1 Unfortunately, false‐positive blood culture results due to specimen contamination with skin bacteria are also common in the ED. J . In the past, a blood culture contamination rate of less than 3% was deemed acceptable. The total blood culture contamination rate in January-March 2019 decreased to 3.1%. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure, which led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate. Current literature Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. The use of the diversion device reduced the rate of blood culture contamination from 1.78% to 0.22%, without reducing the sensitivity for detection of true bacteremia and candidemia. Impact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of . We hypothesized that initial blood specimen diversion without a designated device or procedure would suffice for reduction in blood culture . Practical steps to lower blood culture contamination rates in the emergency department. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED. After reviewing the literature, it was clear that a procedure that is feasible in the fast paced Emergency Department and ensures maximum efficacy of the chlorhexidine for site prep is essential. Subsequent data over 1 year revealed the contamination rates ranged from 0.2% to 1.51%, with a mean of 0.87%. EDs' positive BC rates have been shown to range from 3.4%-7.9% with contamination rates 0.6-7.9%. Purpose: However, more recent studies have demonstrated that contamination rates of less than 1% are readily achievable. Same-site collection rates decreased from 15.13% to 4.14%. The blood culture is an essential tool for diagnosing bloodstream infections and guiding antibiotic therapy. 1, p. Global Journal on Quality and Safety in Healthcare, Vol. A. Results: There was a statistically significant reduction in the number of contaminants (p . We hypothesized that the introduction of a standardized . Blood cultures are commonly performed in the emergency department (ED) due to the important diagnostic and prognostic information they can provide to clinicians. A Quality Improvement team was created to try to reduce contamination rates to the recommended target. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. 1 Contamination of blood cultures contribute to unnecessary return visits, diagnostic studies, and . . There was a significant increase in our monthly blood culture contamination rates, over a 3 month period of time, which exceeded a recommended standard of <3%, as high as 4.35%. Conclusions The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. The median contamination rate by clinical assessment (2.1%) was significantly lower (P = .005), primarily because of a lower proportion of cultures with coagulase-negative Staphylococcus that were interpreted as contaminants when only one of multiple specimens was positive. 2 - 8 patients who … (2018). Pediatrics, 131(1), e292-e297. (2006). Of note, none of the three antiseptic agents was associated with a lower blood culture contamination rate when assessed by univariate and multivariate analysis and in subgroup analysis among older . Introduction: The blood culture (BC) contamination was a significant problem in our hospital, especially in the emergency department (ED). High peripheral blood culture contamination rates (BCCR) in the emergency department (ED) contribute to overuse and harm. 1, p. Reducing false-positive peripheral blood cultures in a pediatric emergency department. 26 27 Faced with these contamination rates clinicians cannot be sufficiently confident in initial positive BC results to alter patient management. Methods Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. A Quality Improvement team was created to try to reduce contamination rates to the recommended target. Contaminated blood cultures add an exorbitant financial . August 25, 2021. Marini, M. (2013, September). All 13 studies reported sustained contamination rates of 1% or below when Steripath was used in the emergency department, . • Rates of blood culture contamination can be as high as 6%2. Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates. Fig. 1, Issue. 2013 Sep;39(5):459-64. doi: 10.1016/j.jen.2012.03.006. Blood culture is an essential and commonly used diagnostic tool in pediatrics, because it is the gold standard test used to detect bacteremia in patients suspected of having serious infections. Blood culture contamination in emergency departments (ED) that experience a high volume of patients has negative impacts on optimal patient care. 3% blood culture contamination rate in an Emergency Department Cultures / month: Contamination Rate: Patients impacted by false positives / month: . From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. Fig. Reducing Blood Culture Contaminations in the Emergency Department: It Takes a Team The results show that reducing blood culture contamination rates through the use of a structured plan and teamwork is feasible in the fast-paced emergency department. The November data of the blood culture contamination rate in the emergency department and the national average are two distinct data that are available at this stage of the paradigm. Using Shared Governance to Reduce Blood Culture Contamination Rates in the Emergency Department. 1 Unfortunately, blood culture contamination is common, leading to increased morbidity and overall cost burden. Confidential . A. The commitment from our team was considered the most valuable asset and strategy. J . This study describes 2 years of quality improvement (QI) interventions that aimed to decrease a high BCCR in a pediatric ED. Methods: The study was conducted for 1 year divided into two phases of 6 months each: Preintervention phase and intervention phase (regular and phlebotomist groups). To promote proper technique related to blood culture specimen collection in an effort to reduce contamination, educational interventions have been examined. Conclusions: The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. Blood culture contamination carries risks for patients, such as unnecessary antimicrobial therapy and other additional hazards and costs. EDs' positive BC rates have been shown to range from 3.4%-7.9% with contamination rates 0.6-7.9%. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Discussion The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. In total, 8,525 blood culture sets were received in January-March 2019; of these, the EDs contributed 2,799 sets (32.8%). Journal of Emergency Nursing, 39(5), 440-456. Local problem: Blood culture contamination rates trailed the national threshold of less than 3% in one southeastern US emergency department (ED). Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Compared with 2008, BCC rates for the ED showed steady reduction from 5.52 to 1.42% in 2011 and leveled out consistently below 1.6%. Journal of Emergency Nursing, 39(5), 459- 464. 2013;131(1):e292-7. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. Journal of Emergency Nursing, 44(6): 570-575. Blood culture contamination can lead to overuse and misuse of antibiotics. Pediatrics. Setting: Busy 32 bed ED. Both EDs A and B showed decreases in their contamination rates to 5.5% and 7.4%, respectively, in 2018-2019. Background Blood culture contamination in emergency departments (ED) that experience a high volume of patients has negative impacts on optimal patient care. Steps to lowering blood culture contamination rates in the ED. 1, p. . The study, therefore, was undertaken to improve the BC collection in the ED. Methods: The QI team created a Key Driver Diagram with multiple Plan-Do-Study-Act (PDSA) cycles. 1 Global Journal on Quality and Safety in Healthcare, Vol. This can delay early targeted treatment and be detrimental to patient care. Hall RT, Domenico HJ, Self WH, Hain PD. Blood cultures in the emergency department (ED) are frequently overused and their use does not follow recommendations and guidelines. 1 however, false positive blood cultures due to specimen contamination with skin bacteria are a common problem that leads to unnecessary patient morbidity, increased hospital costs, and health care system inefficiencies. © 2019 Wolters Kluwer Health, Inc. Conclusions: The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs. Compared with 2008, BCC rates for the ED showed steady reduction from 5.52 to 1.42% in 2011 and leveled out consistently below 1.6%. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Purpose Steripath is a pre-assembled, sterile blood culture system designed to divert and sequester the initial 1.5 to 2.0 mL of blood prior to culture bottle inoculation.Credit: Magnolia Medical Tech. The associated cost of contamination per blood culture is estimated to range between $2844 . Several suggestions have been proposed for ways to reduce blood culture contamination rates. In 2014, the National Hospital Ambulatory Medical Care Survey estimated that ED clinicians had obtained over 840,000 blood cultures on children in EDs in the United States. This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention . (Fig. Same-site collection rates decreased from 15.13% to 4.14%. Perhaps the most striking result is that 97% of positive cultures represented true positives with the diversion device, compared to 81% without the diversion device. For ED and inpatient cultures combined, the rate dropped from 2.46 percent to 1.70 percent. The secondary aim was to decrease the peripheral blood culture ordering rate (BCOR) by 10% within 24 months. (2006). 2. Updated review of blood culture contamination. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month.