Elimination of Blood Culture Contamination in the Emergency Department

Abstract

Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: Blood cultures are frequently obtained in the care of patients with potentially serious infections to detect bacteremia. Blood culture contaminations are a common problem, particularly false-positive blood cultures. These are often the result of contamination from faulty aseptic techniques. This can lead to delays in proper treatment which leads to increased length of stay and increased costs, and decreased patient satisfaction. The international benchmark for blood culture contamination is 3%. This medical center is below this threshold at 1.28% for the month of July 2017. The year to date average is 0.75%. However, this does not satisfy the ED’s desire for 0 blood culture contaminations for superior patient care. Design: This project was a joint effort with the laboratory and the ED, designed as a quality improvement project. Setting: This community medical center is a 500+ bed community hospital in Toms River, New Jersey. Our project was based in the 80 bed emergency department. Participants/Subjects: All ED staff who obtain blood culture specimens were included in this project. Any team member who obtained a contaminated specimen was involved in the remediation process. Methods: Utilizing the PDCA method, we made small frequent cycles of change, including: remediation of staff who were identified as having a contaminated blood culture specimen (remediation involved demonstration of current technique, and teaching and return demonstration of proper technique); direct observation of real time blood culture specimen techniques and "just in time" education; weekly data from the laboratory with contaminated specimens; online learning module for all clinical ED staff; addition of blood culture collection techniques to annual mandatory education for all clinical staff. Results/Outcomes: Blood culture contamination rates in this ED have decreased to 0.4% at the end of 2017. Implications: Through strict adherence to policy, engagement of the team as to “the why” and remediation, blood culture contamination rates have decreased. Through continued efforts, we expect to be able to attain our goal of zero blood culture contaminations, which will improve the patient care and the patient experience in the ED. Close collaboration with the laboratory is necessary for this process to work, as nearly real time data brings home the message for the team members involved in the specimen collection process.