Blood Culture Contamination in the Emergency Department
Repository Posting Date2017-12-05T21:29:32Z
Author DetailsSharon Winters, LPN; Patricia McClure, BSN, RN, CEN, CPEN
Lead Author Sigma AffliationNon-member
Level of EvidenceN/A
Session G presented Saturday, September 16, 2017
Purpose: Current best practice for collecting blood cultures is to divert the first 1-2ml of blood, so to send the micro-organisms away from the blood culture tubes that will be tested. Residing in the deeper dermis layer of skin, are still 20% of common contaminate organisms such as MRSA and VRE, that do not go away even after scrubbing for 30 seconds with chlorahexadine and allowing it to dry completely. Drawing into syringes is not best practice, as we have found alongside with our micro department, that contaminates are being resulted in both the aerobic and anaerobic bottles from mixing of the blood in the syringes. Current practice of using syringes utilizes non-retractable sharps which could cause an employee needlestick. Furthermore, the vacutainer devices do not allow for controlled pressure-flow, increases the likelihood of hemolysis as well as peripheral line compromise. This proposed device allows for control of flow, is a closed loop system, eliminates the risk of needlesticks, and eliminates epithelial contamination from the dermis. The resulting contaminates are leading to increased antibiotic resistance, increased repeat testing, increased length of stays, and costing the healthcare system a tremendous amount of money. Reducing our contamination rates would directly coincide with the system and GCMC's lean strategic planning goals of reducing infections and length of stays.
Design: This was a quality initiative for our department to reduce blood culture contaminations in the emergency department.
Setting: Busy 32 bed ED. Part of a 5 hospital health system, in urban lee county community. See an average of 230 patient visits a day.
Participants/Subjects: All ED Staff participated in this project. Anyone who would be responsible for drawing a patients' set of blood cultures received training.
Methods: Obtained weekly reports from microbiology as to our contamination rates. Kept track of every device used and on which draws to correlate if it was with or without the new device.
Results/Outcomes: Decreased our blood culture contamination rate from 6.1 percent with an average of 30 patients affected a month to 0% contamination with use of new device.
Implications: Recommendation to use the new device as it was proven best practice and significantly decreased our contamination rate in the department. Though policy and process are always important, at some point we have to use the new medical equipment being invented. It falls on the same premise of clean catch urine specimens and worked tremendously for us here at Gulf Coast. We have projected a cost avoidance of over 9 million dollars based on white papers of cost of one culture contamination and have implemented use of the device across all four acute care emergency departments in our system.