ER Pilot Leads to Hospital-wide Implementation of Blood Culture Device

Abstract

Session G presented Friday, September 28, 1:00-2:00 pm Purpose: Blood culture (BC) collection plays a primary role in the diagnosis of infections. False-positive cultures can lead to unnecessary antibiotic treatment, untoward consequences, ELOS, and increased costs. The blood culture contamination (BCC) rate in the emergency room (ER) has remained greater than 3% despite repeated training on antisepsis techniques at the venipuncture site. The ENA Clinical Practice Guideline: Prevention of Blood Culture Contamination (2016) identified the Steripath (SP) blood culture collection device (Magnolia Medical Technologies) as an effective method for decreasing BCC. Skin fragments and skin-residing bacteria have been shown to reside in the initial 1.5-2.0 ml of a blood sample. The SP device diverts this initial blood sample, along with contaminants and sequesters it away, allowing a non-contaminated sample to be drawn for the blood culture. The ER Quality Improvement Committee decided to conduct a pilot study of SP implementation in the ER, results of which led to the hospital-wide use of SP. Design: A quality improvement pilot study on BCC rate was conducted in the ER using SP. The successful reduction in BCC rate using SP led to a hospital-wide implementation. Setting: Urban government teaching hospital in southeast Texas </po> Participants/Subjects: All patients presenting to the ER requiring blood culture samples for suspected infection during the study period. Methods: All staff responsible for BC collection received training on use of the SP device. For the ER study, the SP device was used for all blood culture collection between 0600 and midnight. Usual care (UC) was used for all other BC collection. BCC data for both BC collection methods was collected during the study period. SP was later implemented hospital-wide and BCC data was collected. Results/Outcomes: During the ER pilot study, 558 BC were drawn over a six-week period (9/13/2016-11/1/2016), with 18 contaminations (18/558, 3.2%) identified; 321 BC collected using SP method, and 237 BC collected using UC method. There were 5 contaminations in the SP group (5/321, 1.5%); one result was inconclusive due to only one BC set being dawn. The UC group had 13 contaminations (13/237, 5.5%). Hospital-wide implementation of SP began in 9/28/2017. The ER BCC rate for the first 2 weeks was 0/187 for 0% contaminations. However, October supply problems severely limited SP use. October hospital wide BCC rate using both SP and UC methods was 29/960, compared to November rate, when supplies were available, of 16/996 for a 47% improvement. Implications: SP implementation in the ER during the pilot study resulted in a 73% decrease (P=.01) in BCC rate when compared with UC. The results from the ER study were so strong that Hospital Leadership made the decision to implement the SP device in all departments. For the first month of full SP implementation (November 2017), there was a 56% decrease in the hospital-wide BCC rate (1.6%) compared to the pre-implementation rate of 3.6% in August, 2017, with all departments showing significant improvement. The initial reduction in BCC rates was such that Hospital Leadership decided to continue using the SP device indefinitely.