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Lynge R, Kirkvaag CI, Eilenberger IH, Hansen AMD, Smith J. To disinfect or not to disinfect that is the question - Procedure when drawing blood for alcohol measurements in Denmark. Pract Lab Med 2024; 39:e00381. [PMID: 38562674 PMCID: PMC10982554 DOI: 10.1016/j.plabm.2024.e00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
Swabbing with ethanol to disinfect the skin before venipuncture does not bias measurements of blood ethanol, as previously suspected. International evidence-based theory may not always be successfully integrated into local practices, where old customs may remain. So how are the local protocols for swabbing in practice - if they even do swab? Not disinfecting may risk patient safety. We aim to put a focus on the venipuncture disinfection procedure in practice when measuring blood alcohol for clinical matters and if their procedure refers to a guideline. Specialized biomedical laboratory scientists (BLS) are typically responsible for the phlebotomy procedure in Denmark, thus questionnaires were sent to the relevant BLS in 2020 to map disinfection procedures in all Danish hospitals and affiliated blood draw clinics (n = 58). The response rate was 93% (54/58). We observed an inter-laboratory dissimilarity in swabbing procedures, when measuring blood alcohol: A quarter did not use any disinfectant (26%), while the remaining disinfected with ethanol 55%, isopropanol 13%, and 6% with ethanol/chlorhexidine. Of the five Danish regions, three had a regional guideline (3/5), otherwise the swabbing protocol was locally based. There was a regional difference in disinfecting or not (Chi2 p < 0,0001). Danish protocols do not always parallel international literature and international guidelines. Not applying disinfectant may jeopardize patient safety. Laboratories are encouraged to work with evidence-based practice or follow newest standardized international guidelines.
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Affiliation(s)
- Rebekka Lynge
- Biomedical Laboratory Science, Department of Technology, Faculty of Health, University College Copenhagen, Denmark
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christina I Kirkvaag
- Biomedical Laboratory Science, Department of Technology, Faculty of Health, University College Copenhagen, Denmark
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ida H Eilenberger
- Biomedical Laboratory Science, Department of Technology, Faculty of Health, University College Copenhagen, Denmark
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anne M D Hansen
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Julie Smith
- Biomedical Laboratory Science, Department of Technology, Faculty of Health, University College Copenhagen, Denmark
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Ota K, Nishioka D, Hamada E, Ota K, Shibata Y, Takasu A. Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study. J Gen Fam Med 2024; 25:45-52. [PMID: 38239999 PMCID: PMC10792313 DOI: 10.1002/jgf2.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024] Open
Abstract
Background We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. Methods This single-center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13-month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Results Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true-positive results for bacteremia, and 324 (59.1%) patients showed true-negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone-iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7-22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3-31.9, p < 0.001 and 41.1%, 95% CI 22.2-59.9, p < 0.001, respectively). Conclusion Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant.
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Affiliation(s)
- Koshi Ota
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Daisuke Nishioka
- Research and Development CenterOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Emi Hamada
- Department of NursingOsaka Medical and Pharmaceutical University HospitalTakatsuki CityJapan
| | - Kanna Ota
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
| | - Yuriko Shibata
- Department of Clinical LaboratoryOsaka Medical and Pharmaceutical University HospitalTakatsuki CityJapan
| | - Akira Takasu
- Department of Emergency MedicineOsaka Medical and Pharmaceutical UniversityTakatsuki CityJapan
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Minami K, Yamada T, Yoshioka K, Kawanishi F, Ogawa T, Ukimura A. Effect of the introduction of a management bundle for blood culture collection. Am J Infect Control 2022; 50:772-776. [PMID: 34863897 DOI: 10.1016/j.ajic.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inappropriate blood collection subjected to blood culture (BC) causes BC contamination and may complicate the diagnose is of infectious diseases. Therefore, we developed a bundle based on the guideline recommendations for appropriate blood collection and examined the effects of bundle introduction. METHODS We performed a retrospective analysis of BC samples to determine the contamination rates before and after introducing the BC bundle. We also analyzed the correlation between the compliance rate of the bundle and contamination rate, and between each bundle element and contamination. RESULTS After the introduction of the bundle, the contamination rate was significantly reduced from 5.4% ± 0.9% to 1.7± 0.7% (P < .01). The compliance rate of the bundle was significantly associated with a lower contamination rate (P < .01). Multivariable logistic regression showed that collection from superficial veins of the cubital fossa (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.13-0.51, P < .01) and disinfection of the skin at the blood collection site with 1% chlorhexidine alcohol swab (OR, 0.41; 95% CI, 0.25-0.68, P < .01) were significantly associated with lower contamination. CONCLUSIONS This study suggests that the introduction of the BC bundle significantly reduced the contamination rate, and bundle compliance was associated with a lower contamination rate.
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Affiliation(s)
- Kenta Minami
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Department of Central Clinical Laboratory, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
| | - Tomoyuki Yamada
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kyouhei Yoshioka
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Fumiko Kawanishi
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Taku Ogawa
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Department of Microbiology and Infection Control, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan; Department of Central Clinical Laboratory, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
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Regression discontinuity of blood culture contamination rate after changing of disinfectants: retrospective observational study. Sci Rep 2021; 11:21235. [PMID: 34707137 PMCID: PMC8551281 DOI: 10.1038/s41598-021-00498-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
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. 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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Garcia J, Pempek J, Hengy M, Hinds A, Diaz-Campos D, Habing G. Prevalence and predictors of bacteremia in dairy calves with diarrhea. J Dairy Sci 2021; 105:807-817. [PMID: 34656356 DOI: 10.3168/jds.2020-19819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
Gastrointestinal disease is the most common cause of mortality in dairy calves. Septicemia is an important sequela of diarrhea, and the possibility of bacteremia is the primary justification for empirical antimicrobial therapy. Prior reports estimate that approximately one-third of diarrheic calves are bacteremic; however, those estimates may not be representative of routine cases in heifer calves on commercial dairy operations early in the course of disease. We hypothesized that the prevalence of bacteremia in calves with diarrhea and systemic signs of illness is less than prior estimates (~31%), and that clinical signs or hematological values would be associated with the presence or absence of bacteremia. Female calves less than 21 d of age with and without diarrhea were enrolled from 2 commercial dairy farms over a 10-wk period. Diarrheic calves were enrolled if they were newly diagnosed, had loose to watery stool, had either dehydration (assessed by skin tent and eye position) or depression (assessed by suckle reflex and standing ability), and had no prior antimicrobial treatments. Complete health assessments were conducted at 0, 7, and 14 d following enrollment. An aseptic jugular venous sample was collected and cultured using aerobic and anaerobic methods, and bacterial species were identified using mass spectrometry. Poisson regression models were used to identify associations with bacteremia and compute adjusted prevalence ratios. The prevalence of bacteremia in diarrheic and healthy calves was 9.26% (10/108, 95% confidence interval: 4.5-16%) and 14.8% (4/27, 95% confidence interval: 1.4-28.2%), respectively. Among calves with diarrhea, those with a fever (>39.7°C) or depression were 4.8 and 6.5 times more likely, respectively, to have bacteremia. Only 1 of 47 calves (2%) without signs of depression was bacteremic. The prevalence of bacteremia in diarrheic calves with signs of systemic illness (depression or dehydration) was significantly lower than previous estimates, and bacteremia was rare among calves without observed depression. Antimicrobial therapy targeting bacteremia is not currently justified in routine cases of diarrhea in preweaning calves without signs of depression. These results suggest a substantial opportunity for more targeted antimicrobial therapy to improve antimicrobial stewardship.
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Affiliation(s)
- Jessica Garcia
- College of Veterinary Medicine, The Ohio State University, 1900 Coffey Rd, Columbus 43210
| | - Jessica Pempek
- Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, 1920 Coffey Rd, Columbus 43210
| | - Miranda Hengy
- College of Veterinary Medicine, The Ohio State University, 1900 Coffey Rd, Columbus 43210
| | - Austin Hinds
- Department of Veterinary Medicine and Surgery, University of Missouri, College of Veterinary Medicine, 1520 East, Rollins St, Columbia 65211
| | - Dubraska Diaz-Campos
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon L Tharp St, Columbus 43210
| | - Gregory Habing
- Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, 1920 Coffey Rd, Columbus 43210.
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A Quality Improvement Initiative to Reduce Blood Culture Contamination in the Neonatal Unit. Pediatr Qual Saf 2021; 6:e413. [PMID: 34046542 PMCID: PMC8143735 DOI: 10.1097/pq9.0000000000000413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Peripheral blood culture contamination (BCC) can lead to an initiation of unnecessary antimicrobial treatment, further laboratory tests, increased length of stay, and increased costs. This study describes a 12-month quality improvement (QI) program to reduce the BCC rate in a neonatal unit by 50%. Methods The QI team focused on standardizing processes to align with best practices using process mapping and cause and effect diagrams. Plan-Do-Study-Act (PDSA) 1: inoculation of blood culture bottles with the introduction of transfer device; PDSA 2: preparation of the skin for peripheral intravenous cannula insertion; PDSA 3: aseptic technique education package; and PDSA 4: optimizing blood volume of blood collected for culture. The team used statistical process control methodology to detect special cause variation. Results Compliance with the standard processes as part of PSDA 1 improved from a mean level of 50% to 100% and for PDSA 2 improved from a mean level of 50% to 95%. After implementation of PDSA 3, scores on a relevant knowledge test increased from a mean of 39% (pretraining test; n = 10) to 92% (posttraining test; n = 10) (P < 0.001). Postimplementation of the processes for PDSA 4, a minimum of 1 mL was collected in 94% of blood culture collection events (n = 450) (mean 1.1 mL; range 0.5-3.5 mL). Special cause variation occurred after the implementation of the PDSA cycles. During the baseline period, the BCC rate was 2.0% and decreased to 1.0% postinterventions implementation. Conclusions Interventions focused on standardizing practices around collection of blood cultures in neonates were associated with fewer contaminants.This study is reported according to the SQUIRE 2.0 guidelines.
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Ota K, Oba K, Fukui K, Ito Y, Hamada E, Mori N, Oka M, Ota K, Shibata Y, Takasu A. Sites of blood collection and topical antiseptics associated with contaminated cultures: prospective observational study. Sci Rep 2021; 11:6211. [PMID: 33737624 PMCID: PMC7973780 DOI: 10.1038/s41598-021-85614-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/26/2021] [Indexed: 11/14/2022] Open
Abstract
We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8–16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2–17.9; P < 0.001]) vs. 17.3% (95% CI 3.6–31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.
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Affiliation(s)
- Koshi Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan.
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Fukui
- Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Yuri Ito
- Research and Development Center, Osaka Medical College, Osaka, Japan
| | - Emi Hamada
- Department of Nursing, Osaka Medical College Hospital, Osaka, Japan
| | - Naomi Mori
- Department of Nursing, Osaka Medical College Hospital, Osaka, Japan
| | - Masahiro Oka
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Kanna Ota
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
| | - Yuriko Shibata
- Department of Clinical Laboratory, Osaka Medical College Hospital, Osaka, Japan
| | - Akira Takasu
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan
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Arenas M, Boseman GM, Coppin JD, Lukey J, Jinadatha C, Navarathna DH. Asynchronous Testing of 2 Specimen-Diversion Devices to Reduce Blood Culture Contamination: A Single-Site Product Supply Quality Improvement Project. J Emerg Nurs 2021; 47:256-264.e6. [PMID: 33431137 DOI: 10.1016/j.jen.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Blood culture contamination above the national threshold has been a consistent clinical issue in the ED setting. Two commercially available devices were examined that divert an initial small volume of the specimen before the collection of blood culture to reduce skin contamination. METHODS Prospectively, 2 different blood culture-diversion devices were made available in the unit supplies to ED clinicians at a single site during 2 different periods of time as a follow-up strategy to an ongoing quality improvement project. Blood samples were collected in the emergency department over a period of 16 months. A retrospective record review study was conducted comparing the use of the 2 specimen-diversion devices with no device (control group) for blood culture contamination rates. The main outcome of monthly blood culture contamination per device was tested using a Bayesian Poisson multilevel regression model. RESULTS A total of 4030 blood samples were collected and analyzed from November 2017 to February 2019. The model estimated that the mean incidence of contaminated blood draws in the device A group was 0.29 (0.14-0.55) times the incidence of contaminated draws in the control group. The mean incidence of contaminated blood draws in the device B group was 0.23 (0.13-0.37) times the incidence of contaminated draws in the control group, suggesting that initial-diversion methods reduced blood culture contamination. CONCLUSION Initial specimen-diversion devices supplement present standard phlebotomy protocols to bring down the blood culture contamination rate.
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Blood culture contamination in the emergency department: An integrative review of strategies to prevent blood culture contamination. Australas Emerg Care 2020; 23:157-165. [PMID: 32253130 DOI: 10.1016/j.auec.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood culture collection remains the gold standard to diagnose bacteraemia. 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. The aim of this review is to identify effective strategies to improve blood culture collection in EDs to decrease contamination rates and improve patient safety. METHODS An integrative literature review methodology was utilised to conduct a structured search of contemporary literature using CINAHL, Embase, Medline, Pubmed and Scopus databases. All eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. RESULTS Eleven reports were included in the final review, which identified bundled approaches, education and feedback, equipment and technique, and stakeholder engagement as strategies that improve BCC rates in the ED. CONCLUSIONS All studies reported a reduction in BCC rates regardless of the strategies implemented. A bundled approach yielded the most significant results and was identified to be practical, inexpensive, and adaptable. Further research focusing on specific aspects of a bundled approach may be beneficial to understand which strategies are most effective.
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Kai M, Miyamoto K, Akamatsu K, Tsujita A, Nishio M. Effect of a bundle-approach intervention against contamination of blood culture in the emergency department. J Infect Chemother 2020; 26:785-789. [PMID: 32249163 DOI: 10.1016/j.jiac.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To prevent contamination when taking blood culture, there are various effective interventions. Whether there is greater efficacy by using a combination of these interventions has not been widely evaluated. METHODS Our six-element intervention bundle aimed to prevent contamination of blood culture in our emergency department (ED). Elements were: use of 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, using sterile gloves, using holed sterile cover, and selection of upper extremities as the site of venipuncture. We compared the contamination rate of blood culture between the pre- and the post-intervention periods among all cases with two or more blood cultures taken in our ED. We also evaluated the rate of patients receiving vancomycin among all those transferred to the hospital from the ED. RESULTS During the pre- and post-intervention periods, 460 and 450 cases were included in analysis, respectively. Contamination of blood culture occurred in 29 pre-intervention cases (6.3%) and five post-interventional cases (1.1%) (relative risk 0.18, 95% confidence interval 0.07 to 0.45; P < 0.001). After bundle implementation, there was significant increase in adherence to using 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, and using holed sterile covers. Among patients admitted to hospital, fewer patients received vancomycin during the post-intervention period than in the pre-intervention period (5.4% vs. 3.2%, P = 0.03). CONCLUSIONS Our intervention bundle dramatically reduced the contamination rate when drawing blood culture in our ED.
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Affiliation(s)
- Masato Kai
- Department of Nursing, Wakayama Medical University Hospital, Japan.
| | - Kyohei Miyamoto
- Department of Infection Prevention and Control, Wakayama Medical University Hospital, Japan; Department of Emergency and Critical Care Medicine, Wakayama Medical University, Japan.
| | - Keiichiro Akamatsu
- Department of Infection Prevention and Control, Wakayama Medical University Hospital, Japan; Third Department of Internal Medicine, Wakayama Medical University, Japan.
| | - Ai Tsujita
- Department of Infection Prevention and Control, Wakayama Medical University Hospital, Japan; Clinical Laboratory Department, Wakayama Medical University Hospital, Japan.
| | - Machiko Nishio
- Department of Infection Prevention and Control, Wakayama Medical University Hospital, Japan; Department of Microbiology, School of Medicine, Wakayama Medical University, Japan.
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Afzal A, Kaplan H, Motazedi T, Qureshi T, Woc-Colburn L. Diagnostics: The Role of the Laboratory. HIGHLY INFECTIOUS DISEASES IN CRITICAL CARE 2020:37-68. [DOI: 10.1007/978-3-030-33803-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Doern GV, Carroll KC, Diekema DJ, Garey KW, Rupp ME, Weinstein MP, Sexton DJ. Practical Guidance for Clinical Microbiology Laboratories: A Comprehensive Update on the Problem of Blood Culture Contamination and a Discussion of Methods for Addressing the Problem. Clin Microbiol Rev 2019; 33:e00009-19. [PMID: 31666280 PMCID: PMC6822992 DOI: 10.1128/cmr.00009-19] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In this review, we present a comprehensive discussion of matters related to the problem of blood culture contamination. Issues addressed include the scope and magnitude of the problem, the bacteria most often recognized as contaminants, the impact of blood culture contamination on clinical microbiology laboratory function, the economic and clinical ramifications of contamination, and, perhaps most importantly, a systematic discussion of solutions to the problem. We conclude by providing a series of unanswered questions that pertain to this important issue.
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Affiliation(s)
- Gary V Doern
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Diekema
- Division of Infectious Diseases, Department of Medicine and Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Mark E Rupp
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melvin P Weinstein
- Department of Pathology and Laboratory Medicine, Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Daniel J Sexton
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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13
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Lalezari A, Cohen MJ, Svinik O, Tel-Zur O, Sinvani S, Al-Dayem YA, Block C, Moses AE, Oster Y, Salameh S, Strahilevitz J. A simplified blood culture sampling protocol for reducing contamination and costs: a randomized controlled trial. Clin Microbiol Infect 2019; 26:470-474. [PMID: 31539635 DOI: 10.1016/j.cmi.2019.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Blood culture contamination carries risks for patients, such as unnecessary antimicrobial therapy and other additional hazards and costs. One method shown to be effective in reducing contamination is initial blood specimen diversion during collection. We hypothesized that initial blood specimen diversion without a designated device or procedure would suffice for reduction in blood culture contamination rate. METHODS From 1 September 2017 through to 6 September 2018, we conducted a randomized controlled trial to assess the effect of an initial-specimen diversion technique (ISDT) on the rate of blood-culture contamination by changing the order of sampling using regular vacuum specimen tubes instead of commercially available sterile diversion devices. We included adults from whom the treating physician planned to take blood cultures and additional blood chemistry tests. Additionally, we evaluated the potential economic benefits of an ISDT. This was a researcher-initiated trial, Clinicaltrials.gov NCT03088865. RESULTS In all, 756 patients were enrolled. This method, compared with the standard procedure in use at our medical centre, reduced contamination by 66% (95% CI 17%-86%), from 20/400 (5%) with the standard method to 6/356 (1.6%) with the ISDT, without compromising detection of true bloodstream infection and at no additional cost. Hospital-wide implementation of ISDT was associated with a 1.1% saving in hospitalization days. CONCLUSIONS We offer this novel approach as a simple, cost-effective measure to reduce risks to patient safety from contaminated blood cultures, without the need for using costly devices.
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Affiliation(s)
- A Lalezari
- Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - M J Cohen
- Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - O Svinik
- Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - O Tel-Zur
- Department of Emergency Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - S Sinvani
- Department of Emergency Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - Y Abed Al-Dayem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, The Hebrew University, Jerusalem, Israel
| | - C Block
- Hadassah-Hebrew University School of Medicine, Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, The Hebrew University, Jerusalem, Israel
| | - A E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, The Hebrew University, Jerusalem, Israel
| | - Y Oster
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, The Hebrew University, Jerusalem, Israel
| | - S Salameh
- Department of Emergency Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - J Strahilevitz
- Hadassah-Hebrew University School of Medicine, Jerusalem, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, The Hebrew University, Jerusalem, Israel.
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14
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Torossian K, Benayoun S, Ottenio M, Brulez AC. Guidelines for designing a realistic peripheral venous catheter insertion simulator: A literature review. Proc Inst Mech Eng H 2019; 233:963-978. [DOI: 10.1177/0954411919864786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A literature review was conducted to develop more realistic medical simulators that better prepare aspiring health professionals to perform a medical procedure in vivo. Thus, this review proposes an approach that might assist researchers design improved medical simulators, particularly new materials that would enhance the sensation of touch for skin substitutes. By targeting the current needs in the field of simulation learning, we concluded that peripheral venous catheter insertion simulators lack realistic haptic feedback. Enhanced peripheral venous catheter insertion simulators will accelerate the mastery of the medical procedure, thus decreasing the number of failures in patients and costs related to this procedure.
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Affiliation(s)
- Kevin Torossian
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Écully, France
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Stéphane Benayoun
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Écully, France
| | - Mélanie Ottenio
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Anne-Catherine Brulez
- Laboratoire de Génie de la Fonctionnalisation des Matériaux Polymères, Institut Textile et Chimique de Lyon, Écully, France
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15
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Yodoshi T, Ueda S, Goldman RD. Skin preparation for prevention of peripheral blood culture contamination in children. Pediatr Int 2019; 61:647-651. [PMID: 31172642 DOI: 10.1111/ped.13906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Japan, blood cultures for children are performed by pediatric residents, and povidone-iodine (PI) is the recommended solution for skin preparation. Given that PI needs to be applied for 1.5-2 min before venipuncture, skin preparation may be suboptimal if this is not followed. In this study, we investigated the blood culture contamination rate after skin preparation with only 70% isopropyl alcohol (IPA) or IPA plus PI. METHODS We performed a retrospective study of patients aged ≤6 years who provided blood cultures in the emergency department or pediatric ward. Patients with indwelling central venous catheter were excluded. We evaluated the impact of changing the method of skin preparation, comparing the traditional method using IPA plus PI between 2008 and 2010 (IPA + PI group) with the simplified method using only IPA between 2015 and 2017 (IPA group). RESULTS A total of 5,365 blood culture samples were eligible for this study. Of these, 171 (3.2%) had an organism identified in blood culture. Of the blood culture-positive samples, 68 (1.3%) were true positive and 103 (1.9%) were contaminated. Thirty-eight (1.6%) of 2,407 cultures in the IPA group were contaminated, whereas 65 (2.2%) of 2,958 cultures in the IPA + PI group were contaminated (OR, 0.72; 95%CI: 0.48-1.07; P = 0.1). Coagulase-negative Staphylococcus grew significantly less in the IPA group (1.7% vs 1.0%, P = 0.02). CONCLUSIONS A single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures from children in Japan.
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Affiliation(s)
- Toshifumi Yodoshi
- Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan.,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Ran D Goldman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, Jacobs J, Hardy L. Best Practices of Blood Cultures in Low- and Middle-Income Countries. Front Med (Lausanne) 2019; 6:131. [PMID: 31275940 PMCID: PMC6591475 DOI: 10.3389/fmed.2019.00131] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal Salmonella bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on "manual" methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire-Hubert Koutoucou Maga, Cotonou, Benin
| | | | - Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Octavie Lunguya
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo.,Department of Medical Biology, Cliniques Universitaires, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KULeuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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17
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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18
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Hughes JA, Cabilan CJ, Williams J, Ray M, Coyer F. The effectiveness of interventions to reduce peripheral blood culture contamination in acute care: a systematic review protocol. Syst Rev 2018; 7:216. [PMID: 30497526 PMCID: PMC6267024 DOI: 10.1186/s13643-018-0877-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood cultures are an integral part of the diagnosis of bacteremia in unwell patients. The treatment of bacteremia involves the rapid and accurate identification of the causative agent grown from the blood cultures collected. Contamination of blood cultures with non-pathogenic microbes such as skin commensals causes false positive results and subsequent unnecessary and potentially harmful interventions. While guidelines for blood culture quality recommend no more than 2-3% contamination rate, rates up to 12% are reported in the literature. There have been a number of methods proposed to reduce the contamination of blood cultures, including educational interventions, changing of skin cleansing preparations and introduction of blood culture collection packs in acute care settings. This protocol outlines methods to identify and evaluate interventions to reduce blood culture contamination in the acute care setting. METHODS The reviewers will conduct a systematic search of literature in CINHAL, PubMed, EMBASE and the Cochrane Central register of controlled trials. Unpublished works will be identified in ProQuest Dissertations and Theses. Articles will be assessed for relevance based on their title and abstract. Remaining relevant citations will have their full text retrieved and assessed against eligibility criteria. All studies that meet the eligibility criteria will have their methodological quality appraised. Assessments for relevance and methodological quality will be conducted independently by two reviewers. If appropriate, data will be analysed using the Mantel-Haenszel method under a random effects model. Heterogeneity of the studies will be assessed using the I 2 and chi-squared statistic. Meta-analysis will be attempted if the data is suitable. DISCUSSION This review will identify and summarise the interventions previously described in the literature aimed at reducing peripherally collected blood culture contamination rates in acute care. These findings have the potential to lead to multifaceted interventions based on previous evidence to reduce blood culture contamination in the acute setting. Reductions in the proportion of contaminated blood cultures have the potential to save money, unrequired treatment (particularly antimicrobials) and hospital bed days. SYSTEMATIC REVIEW REGISTRATION In accordance with guidelines outlined in the PRISMA-P methodology, this protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on December 8, 2017, and last updated on January 4, 2018 (registration number CRD42017081650).
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Affiliation(s)
- J. A. Hughes
- School of Nursing, Queensland University of Technology, Brisbane, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Ground Floor, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, Queensland 4029 Australia
| | - C. J. Cabilan
- Clinical Research Officer, Emergency Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Australia
| | - Julian Williams
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Ground Floor, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, Queensland 4029 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Mercedes Ray
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Ground Floor, Dr James Mayne Building, Butterfield Street, Herston, Brisbane, Queensland 4029 Australia
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Brisbane, Australia
- Intensive Care Services, Critical Care and Clinical Support Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
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19
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Dargère S, Cormier H, Verdon R. Contaminants in blood cultures: importance, implications, interpretation and prevention. Clin Microbiol Infect 2018; 24:964-969. [DOI: 10.1016/j.cmi.2018.03.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/17/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
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20
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Rupp ME, Cavalieri RJ, Marolf C, Lyden E. Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. Clin Infect Dis 2018; 65:201-205. [PMID: 28379370 PMCID: PMC5849098 DOI: 10.1093/cid/cix304] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/29/2017] [Indexed: 11/14/2022] Open
Abstract
Background Blood culture contamination is a clinically significant problem that results in patient harm and excess cost. Methods In a prospective, controlled trial at an academic center Emergency Department, a device that diverts and sequesters the initial 1.5-2 mL portion of blood (which presumably carries contaminating skin cells and microbes) was tested against standard phlebotomy procedures in patients requiring blood cultures due to clinical suspicion of serious infection. Results In sum, 971 subjects granted informed consent and were enrolled resulting in 904 nonduplicative subjects with 1808 blood cultures. Blood culture contamination was significantly reduced through use of the initial specimen diversion device™ (ISDD) compared to standard procedure: (2/904 [0.22%] ISDD vs 16/904 [1.78%] standard practice, P = .001). Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P = .41. No needlestick injuries or potential bloodborne pathogen exposures were reported. The monthly rate of blood culture contamination for all nurse-drawn and phlebotomist-drawn blood cultures was modeled using Poisson regression to compare the 12-month intervention period to the 6 month before and after periods. Phlebotomists (used the ISDD) experienced a significant decrease in blood culture contamination while the nurses (did not use the ISDD) did not. In sum, 73% of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted. Conclusions Use of the ISDD was associated with a significant decrease in blood culture contamination in patients undergoing blood cultures in an Emergency Department setting. Clinical Trials Registration NCT02102087.
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Affiliation(s)
| | | | | | - Elizabeth Lyden
- Department of Epidemiology, University of Nebraska Medical Center, Omaha
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21
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Sánchez-Sánchez MM, Arias-Rivera S, Fraile-Gamo P, Jareño-Collado R, López-Román S, Vadillo-Obesso P, García-González S, Pulido-Martos MT, Sánchez-Muñoz EI, Cacho-Calvo J, Martín-Pellicer A, Panadero-Del Olmo L, Frutos-Vivar F. Effect of a training programme on blood culture contamination rate in critical care. ENFERMERIA INTENSIVA 2018; 29:121-127. [PMID: 29609850 DOI: 10.1016/j.enfi.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 11/27/2022]
Abstract
Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. OBJECTIVE To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. METHOD Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. VARIABLES demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. RESULTS Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003). CONCLUSION An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.
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Affiliation(s)
- M M Sánchez-Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - S Arias-Rivera
- Enfermería de Investigación, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - P Fraile-Gamo
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - R Jareño-Collado
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - S López-Román
- Consultorio Local Moraleja de Enmedio, Moraleja de Enmedio, Madrid, España
| | | | - S García-González
- Unidad de Cuidados Intensivos, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - M T Pulido-Martos
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, España
| | - E I Sánchez-Muñoz
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - J Cacho-Calvo
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - A Martín-Pellicer
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - L Panadero-Del Olmo
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - F Frutos-Vivar
- Área de Medicina Intensiva, Hospital Universitario de Getafe, Getafe, Madrid, España
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Nishida O, Ogura H, Egi M, Fujishima S, Hayashi Y, Iba T, Imaizumi H, Inoue S, Kakihana Y, Kotani J, Kushimoto S, Masuda Y, Matsuda N, Matsushima A, Nakada TA, Nakagawa S, Nunomiya S, Sadahiro T, Shime N, Yatabe T, Hara Y, Hayashida K, Kondo Y, Sumi Y, Yasuda H, Aoyama K, Azuhata T, Doi K, Doi M, Fujimura N, Fuke R, Fukuda T, Goto K, Hasegawa R, Hashimoto S, Hatakeyama J, Hayakawa M, Hifumi T, Higashibeppu N, Hirai K, Hirose T, Ide K, Kaizuka Y, Kan’o T, Kawasaki T, Kuroda H, Matsuda A, Matsumoto S, Nagae M, Onodera M, Ohnuma T, Oshima K, Saito N, Sakamoto S, Sakuraya M, Sasano M, Sato N, Sawamura A, Shimizu K, Shirai K, Takei T, Takeuchi M, Takimoto K, Taniguchi T, Tatsumi H, Tsuruta R, Yama N, Yamakawa K, Yamashita C, Yamashita K, Yoshida T, Tanaka H, Oda S. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016). J Intensive Care 2018; 6:7. [PMID: 29435330 PMCID: PMC5797365 DOI: 10.1186/s40560-017-0270-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] 10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine. METHODS Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members. RESULTS A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs. CONCLUSIONS Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.
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Affiliation(s)
- Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Moritoki Egi
- Department of anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Imaizumi
- Department of Anesthesiology and Critical Care Medicine, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Shigeaki Inoue
- Department of Emergency and Critical Care Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Matsuda
- Department of Emergency & Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asako Matsushima
- Department of Advancing Acute Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Nakagawa
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shin Nunomiya
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Tomoaki Yatabe
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kochi, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yutaka Kondo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Yuka Sumi
- Healthcare New Frontier Promotion Headquarters Office, Kanagawa Prefectural Government, Yokohama, Japan
| | - Hideto Yasuda
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Takeo Azuhata
- Division of Emergency and Critical Care Medicine, Departmen of Acute Medicine, Nihon university school of Medicine, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary’s Hospital, Westminster, UK
| | - Ryota Fuke
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Tatsuma Fukuda
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Koji Goto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Oita, Japan
| | - Ryuichi Hasegawa
- Department of Emergency and Intensive Care Medicine, Mito Clinical Education and Training Center, Tsukuba University Hospital, Mito Kyodo General Hospital, Mito, Japan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Tsukuba, Japan
| | - Junji Hatakeyama
- Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Miki, Japan
| | - Naoki Higashibeppu
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe City Hospital Organization, Kobe, Japan
| | - Katsuki Hirai
- Department of Pediatrics, Kumamoto Red cross Hospital, Kumamoto, Japan
| | - Tomoya Hirose
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Kentaro Ide
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuo Kaizuka
- Department of Emergency & ICU, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Tomomichi Kan’o
- Department of Emergency & Critical Care Medicine Kitasato University, Tokyo, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Hiromitsu Kuroda
- Department of Anesthesia, Obihiro Kosei Hospital, Obihiro, Japan
| | - Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Shotaro Matsumoto
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Masaharu Nagae
- Department of anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Mutsuo Onodera
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Tetsu Ohnuma
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Nobuyuki Saito
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - So Sakamoto
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Mikio Sasano
- Department of Intensive Care Medicine, Nakagami Hospital, Uruma, Japan
| | - Norio Sato
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Atsushi Sawamura
- Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kunihiro Shirai
- Department of Emergency and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuhiro Takei
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Kohei Takimoto
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Japan
| | - Naoya Yama
- Department of Diagnostic Radiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Kazuto Yamashita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Yoshida
- Intensive Care Unit, Osaka University Hospital, Osaka, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Nishida O, Ogura H, Egi M, Fujishima S, Hayashi Y, Iba T, Imaizumi H, Inoue S, Kakihana Y, Kotani J, Kushimoto S, Masuda Y, Matsuda N, Matsushima A, Nakada T, Nakagawa S, Nunomiya S, Sadahiro T, Shime N, Yatabe T, Hara Y, Hayashida K, Kondo Y, Sumi Y, Yasuda H, Aoyama K, Azuhata T, Doi K, Doi M, Fujimura N, Fuke R, Fukuda T, Goto K, Hasegawa R, Hashimoto S, Hatakeyama J, Hayakawa M, Hifumi T, Higashibeppu N, Hirai K, Hirose T, Ide K, Kaizuka Y, Kan'o T, Kawasaki T, Kuroda H, Matsuda A, Matsumoto S, Nagae M, Onodera M, Ohnuma T, Oshima K, Saito N, Sakamoto S, Sakuraya M, Sasano M, Sato N, Sawamura A, Shimizu K, Shirai K, Takei T, Takeuchi M, Takimoto K, Taniguchi T, Tatsumi H, Tsuruta R, Yama N, Yamakawa K, Yamashita C, Yamashita K, Yoshida T, Tanaka H, Oda S. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016). Acute Med Surg 2018; 5:3-89. [PMID: 29445505 PMCID: PMC5797842 DOI: 10.1002/ams2.322] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. Methods Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (>66.6%) majority vote of each of the 19 committee members. Results A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs. Conclusions Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.
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Maiwald M. Are skin antiseptics for blood culture collection really equal? Commentary on Liu, W., et al., 2016 "Skin antiseptics in venous puncture site disinfection for preventing blood culture contamination: A Bayesian network meta-analysis of randomized controlled trials". Int J Nurs Stud 2017; 75:91-92. [PMID: 28759824 DOI: 10.1016/j.ijnurstu.2017.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Matthias Maiwald
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore; Department of Microbiology, National University of Singapore, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
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Xu C, Peng H, Chai W, Li X, Li R, Chen J. Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study. Med Sci Monit 2017; 23:3571-3577. [PMID: 28733573 PMCID: PMC5536130 DOI: 10.12659/msm.905590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether needles introduce skin plugs into joints during arthrocentesis. MATERIAL AND METHODS In the first part of this study, the arthrocentesis site was scrubbed with a fluorescein sodium swab, and 90 needles were inserted through the joint tissue and collected for examination under a fluorescence microscope. In the second part of this study, the joints were injected using 720 needles of different gauges. Two different randomly assigned needle insertion techniques were used: needle insertion straight through the joint capsule (subgroup 1) or insertion of the needle into the subcutaneous tissue followed by flushing of the needle with 0.5 mL of 0.9% normal saline prior to advancing the needle through the joint capsule (subgroup 2). RESULTS Of the 90 needle tips examined in the first part of this study, 21 had high-grade fluorescein contamination. In the second part of this study, the incidence of tissue, epidermis, and dermis contamination in subgroup 1 was 57.2%, 43.1%, and 25.0%, respectively. There was no significant difference in the incidence among different gauge needles, except for a difference in epidermis contamination between the 21-gauge and 23-gauge needles. Compared to subgroup 1, subgroup 2 had a significantly lower OR for tissue contamination. CONCLUSIONS It is common to introduce tissue coring with epidermis and dermis into the joint during arthrocentesis, which poses a potential risk for septic arthritis. However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule.
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Affiliation(s)
- Chi Xu
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Haiwen Peng
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Wei Chai
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Xiang Li
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Rui Li
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Jiying Chen
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
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Garrido-Benedicto P, Cueto-Quintana P, Farré-Termens E, Mariné-Cabré M, Riba-Reig J, Molina-Chueca R. Efecto de la higiene diaria con clorhexidina sobre la incidencia de contaminaciones de hemocultivos en el paciente crítico. ENFERMERIA INTENSIVA 2017; 28:97-104. [DOI: 10.1016/j.enfi.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
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Implementation of the Theory of Planned Behavior to Promote Compliance with a Chlorhexidine Gluconate Protocol. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.java.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Introduction: Blood cultures are critical values for identifying the source of an infection in patients seeking medical treatment for an acute illness. False-positive cultures can negatively influence patient care when physicians use inaccurate information to prescribe treatment. Inaccurate prescribed treatment negatively influences the quality of patient care related to prolonged medical treatment and hospital stay and unnecessary repetition of diagnostic tests.
Purpose: The purpose of this project was to determine if blood culture contamination rates would be decreased if improved availability of CHG products was provided in all emergency department patient care areas would reduce the contamination rates of blood cultures.
Methodology: The Theory of Planned Behavior provided the theoretical framework for this descriptive correlational project to examine barriers to following the procedural guidelines to cleanse venipuncture sites with a chlorhexidine gluconate (CHG) product before venipuncture Alcohol preparation pads were removed from the emergency department and a CHG product packaged similar to the alcohol preparation pads was placed in the department procedure trays and bedside carts.
Results: During the first 2 weeks of the pilot project, blood culture contamination rates were reduced from 4.5% to 1.5%. The following month, rates remained low at 1.9%.
Conclusion: Placement of CHG products at the bedside will improve patient safety and quality of care by reducing the incidence of inaccurate diagnosis and treatment based on false-positive blood cultures.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peretz A, Kuzniec F, Ganem D, Salman N, Qarawani D, Amir O. The need for maximal sterile barrier precaution in routine interventional coronary procedures; microbiology analysis. Eur J Med Res 2016; 21:45. [PMID: 27832813 PMCID: PMC5103405 DOI: 10.1186/s40001-016-0239-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Maximal sterile barrier precautions (MSBP) including head coverings and face masks are advocated for use in invasive procedures, including coronary interventions. The rationale for MSBP assumes it is an obligatory measure for infection prevention. However, in many coronary catheterization laboratories, head coverings/face masks are not used in daily practice. This study prospectively evaluated the potential hazards of not routinely using head coverings/face masks in routine coronary interventions. Methods This is a prospective study of ambulatory patients in hospital care. A total of 110 successive elective patients undergoing cardiac catheterizations were recruited. Patients were catheterized by several interventional cardiologists who employed only routine infection control precautions without head coverings or face masks. For each patient, we took blood cultures and cultures from the tips of the coronary catheters and from the sterile saline water flush bowl. Cultures were handled and analyzed at our certified hospital microbiology laboratory. Results In none of the cultures was a clinically significant bacterial growth isolated. No signs of infection were reported later by any of the study patients and there were no relevant subsequent admissions. Conclusion Operating in the catheterization lab without head coverings/face masks was not associated with any bacterial infection in multiple blood and equipment cultures. Accordingly, we believe that the use of head coverings/face masks should not be an obligatory requirement and may be used at the interventional cardiologist’s discretion.
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Affiliation(s)
- Avi Peretz
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Tiberias, Israel. .,Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel.
| | - Fabio Kuzniec
- Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Diab Ganem
- Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Nabeeh Salman
- Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Dahud Qarawani
- Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel.,Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Offer Amir
- Faculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel.,Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
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Liu W, Duan Y, Cui W, Li L, Wang X, Dai H, You C, Chen M. Skin antiseptics in venous puncture site disinfection for preventing blood culture contamination: A Bayesian network meta-analysis of randomized controlled trials. Int J Nurs Stud 2016; 59:156-62. [DOI: 10.1016/j.ijnurstu.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/28/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
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Ialongo C, Bernardini S. Phlebotomy, a bridge between laboratory and patient. Biochem Med (Zagreb) 2016; 26:17-33. [PMID: 26981016 PMCID: PMC4783087 DOI: 10.11613/bm.2016.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/06/2015] [Indexed: 12/28/2022] Open
Abstract
The evidence-based paradigm has changed and evolved medical practice. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Nowadays it connects the patient with the clinical laboratory dimension building up a bridge. However, more often there is a gap between laboratory and phlebotomist that causes misunderstandings and burdens on patient safety. Therefore, the scope of this review is delivering a view of modern phlebotomy to "bridge" patient and laboratory. In this regard the paper describes devices, tools and procedures in the light of the most recent scientific findings, also discussing their impact on both quality of blood testing and patient safety. It also addresses the issues concerning medical aspect of venipuncture, like the practical approach to the superficial veins anatomy, as well as the management of the patient's compliance with the blood draw. Thereby, the clinical, technical and practical issues are treated with the same relevance throughout the entire paper.
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Affiliation(s)
- Cristiano Ialongo
- Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Sergio Bernardini
- Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy; Experimental Medicine and Surgery Department, "Tor Vergata" University, Rome, Italy
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Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol 2016; 7:697. [PMID: 27242721 PMCID: PMC4863885 DOI: 10.3389/fmicb.2016.00697] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
Bloodstream infection (BSI) is a major cause of death in developed countries and the detection of microorganisms is essential in managing patients. Despite major progress has been made to improve identification of microorganisms, blood culture (BC) remains the gold standard and the first line tool for detecting BSIs. Consensus guidelines are available to ensure optimal BSI procedures, but BC practices often deviate from the recommendations. This review provides an update on clinical and technical issues related to blood collection and to BC performance, with a special focus on the blood sample strategy to optimize the sensitivity and specificity of BCs.
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Affiliation(s)
- Brigitte Lamy
- Laboratoire de Bactériologie, CHU Montpellier Montpellier, France
| | | | - Maiken C Arendrup
- Unit for Mycology, Department of Microbiology & Infection Control, Statens Serum Institut Copenhagen, Denmark
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Sathiyamurthy S, Banerjee J, Godambe SV. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review. World J Clin Pediatr 2016; 5:159-171. [PMID: 27170926 PMCID: PMC4857229 DOI: 10.5409/wjcp.v5.i2.159] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.
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O'Connor C, Philip RK, Powell J, Slevin B, Quinn C, Power L, O'Connell NH, Dunne CP. Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care. J Hosp Infect 2016; 93:105-7. [PMID: 26944902 DOI: 10.1016/j.jhin.2016.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher's exact test: P = 0.0259). No dermatological sequelae were observed. The improvement has been sustained.
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Affiliation(s)
- C O'Connor
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - R K Philip
- Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Ireland
| | - B Slevin
- Infection Prevention & Control Team, University Hospital Limerick, Ireland
| | - C Quinn
- Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland
| | - L Power
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - C P Dunne
- Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland.
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Garcia RA, Spitzer ED, Beaudry J, Beck C, Diblasi R, Gilleeny-Blabac M, Haugaard C, Heuschneider S, Kranz BP, McLean K, Morales KL, Owens S, Paciella ME, Torregrosa E. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control 2015; 43:1222-37. [PMID: 26298636 DOI: 10.1016/j.ajic.2015.06.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND A literature search was conducted using keywords for articles published in English from January 1990 to March 2015. Using criteria related to blood culture collection and handling, the search yielded 101 articles. References used also included Microbiology Laboratory standards, guidelines, and textbook information. RESULTS The literature identified diverse and complex issues surrounding blood culture practices, including the impact of false-positive results, laboratory definition of contamination, effect on central line-associated bloodstream infection (CLABSI) reporting, indications for collecting blood cultures, drawing from venipuncture sites versus intravascular catheters, selection of antiseptics, use of needleless connectors, inoculation of blood culture bottles, and optimizing program management in emergency departments, education, and implementation of bundled practice initiatives. CONCLUSION Hospitals should optimize best practice in the collection, handling, and management of blood culture specimens, an often overlooked but essential component in providing optimal care of patients in all settings and populations, reducing financial burdens, and increasing the accuracy of reportable CLABSI. Although universal concepts exist in blood culture practices, some issues require further research to determine benefit. Institutions undertaking a review of their blood culture programs are encouraged to use a checklist that addresses elements that encompass the research contained in this review.
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Bonnet A, Devienne M, De Broucker V, Duquennoy-Martinot V, Guerreschi P. Operating room fire: Should we mistrust alcoholic antiseptics? ANN CHIR PLAST ESTH 2015; 60:255-61. [DOI: 10.1016/j.anplas.2015.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
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Nathan AM, de Bruyne JA. Should All Children Admitted with Community Acquired Pneumonia have Blood Cultures Taken? Authors' Reply. Indian J Pediatr 2015; 82:660-1. [PMID: 25514886 DOI: 10.1007/s12098-014-1640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/21/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Marie Nathan
- University Malaya Pediatrics and Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia,
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Webster J, Bell-Syer SEM, Foxlee R. Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion. Cochrane Database Syst Rev 2015; 2015:CD007948. [PMID: 25674776 PMCID: PMC7185566 DOI: 10.1002/14651858.cd007948.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective. OBJECTIVES To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient. SEARCH METHODS In December 2014, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. SELECTION CRITERIA All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. MAIN RESULTS No studies (RCTs or quasi RCTs) met the inclusion criteria. AUTHORS' CONCLUSIONS We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.
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Affiliation(s)
- Joan Webster
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Level 2, Building 34, Butterfield Street, Brisbane, Queensland, Australia, 4029. .
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Ugwumba CU, Adeyemo WL, Odeniyi OM, Arotiba GT, Ogunsola FT. Preoperative administration of 0.2% chlorhexidine mouthrinse reduces the risk of bacteraemia associated with intra-alveolar tooth extraction. J Craniomaxillofac Surg 2014; 42:1783-8. [DOI: 10.1016/j.jcms.2014.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 06/03/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022] Open
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Oda S, Aibiki M, Ikeda T, Imaizumi H, Endo S, Ochiai R, Kotani J, Shime N, Nishida O, Noguchi T, Matsuda N, Hirasawa H. The Japanese guidelines for the management of sepsis. J Intensive Care 2014; 2:55. [PMID: 25705413 PMCID: PMC4336273 DOI: 10.1186/s40560-014-0055-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/16/2014] [Indexed: 02/08/2023] Open
Abstract
This is a guideline for the management of sepsis, developed by the Sepsis Registry Committee of The Japanese Society of Intensive Care Medicine (JSICM) launched in March 2007. This guideline was developed on the basis of evidence-based medicine and focuses on unique treatments in Japan that have not been included in the Surviving Sepsis Campaign guidelines (SSCG), as well as treatments that are viewed differently in Japan and in Western countries. Although the methods in this guideline conform to the 2008 SSCG, the Japanese literature and the results of the Sepsis Registry Survey, which was performed twice by the Sepsis Registry Committee in intensive care units (ICUs) registered with JSICM, are also referred. This is the first and original guideline for sepsis in Japan and is expected to be properly used in daily clinical practice. This article is translated from Japanese, originally published as “The Japanese Guidelines for the Management of Sepsis” in the Journal of the Japanese Society of Intensive Care Medicine (J Jpn Soc Intensive Care Med), 2013; 20:124–73. The original work is at http://dx.doi.org/10.3918/jsicm.20.124.
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Affiliation(s)
- Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba 260-8677 Japan
| | - Mayuki Aibiki
- Department of Emergency Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Toshiaki Ikeda
- Division of Critical Care and Emergency Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Hitoshi Imaizumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556 Japan
| | - Shigeatsu Endo
- Department of Emergency Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-0023 Japan
| | - Ryoichi Ochiai
- First Department of Anesthesia, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8131 Japan
| | - Nobuaki Shime
- Division of Intensive Care Unit, University Hospital, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan
| | - Takayuki Noguchi
- Department of Anesthesiology and Intensive Care Medicine, Oita University School of Medicine, 1-1 Idaigaoka, Hazamacho, Yufu, Oita 879-5593 Japan
| | - Naoyuki Matsuda
- Emergency and Critical Care Medicine, Graduate School of Medicine Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550 Japan
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Abstract
Chlorhexidine is a highly effective antiseptic and disinfectant. In the past 20 years there has been a substantial increase in the number of chlorhexidine containing products used in healthcare. Anaphylaxis to chlorhexidine was first reported in 1984 and was almost always seen in men. However, in the last 4 years we have observed a surge in confirmed cases of anaphylaxis to chlorhexidine, with increasing numbers of female patients recently diagnosed. Yet, awareness of chlorhexidine as a cause of anaphylaxis is low because it is not a drug but a 'hidden' allergen, for example as a coating on medical devices such as central lines and urinary catheters. Patients will often have more than one allergic/anaphylactic reaction before the diagnosis is suspected. We have observed that there is poor recognition of an initial allergic reaction to chlorhexidine, which is well described. This, alongside poor labelling of chlorhexidine containing products, has resulted in further inadvertent exposure resulting in severe anaphylaxis. Prompt referral to a specialist allergy centre ensures appropriate investigations, diagnosis and management. Increasing awareness of the potential risk of life-threatening anaphylaxis associated with chlorhexidine use is vital, particularly in perioperative procedures. Healthcare workers are fundamental in avoiding and preventing further reactions to chlorhexidine containing products in patients diagnosed with anaphylaxis to chlorhexidine.
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Affiliation(s)
- Katy Mara Odedra
- Chest & Allergy Clinic, Mint Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sophie Farooque
- Chest & Allergy Clinic, Mint Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Maiwald M, Chan ESY. Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis. J Antimicrob Chemother 2014; 69:2017-21. [PMID: 24777898 DOI: 10.1093/jac/dku121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Chlorhexidine has attracted increasing attention for its role in skin antisepsis in recent years. It was tested in several prominent clinical trials and subsequently recommended in important guidelines for blood culture collection, vascular catheter insertion and surgical skin preparation. We noticed and subsequently reported a widespread misinterpretation of evidence surrounding chlorhexidine and its role in skin antisepsis. Multiple clinical trial reports and systematic reviews that had assessed the clinical efficacy of chlorhexidine/alcohol combinations for skin antisepsis had attributed efficacy solely to the chlorhexidine component. This misinterpretation was carried over into the tertiary literature, including evidence-based guidelines. Here we discuss some of the scientific, ethical, patient safety and infection control implications of this misinterpretation, as well as broader implications for evidence-based medicine.
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Affiliation(s)
- Matthias Maiwald
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore Department of Microbiology, National University of Singapore, Singapore Duke-NUS Graduate Medical School, Singapore
| | - Edwin S-Y Chan
- Duke-NUS Graduate Medical School, Singapore Singapore Clinical Research Institute, Singapore Singapore Branch, Australasian Cochrane Centre, Singapore
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Gori E, Callea E, Alberani F, Orlando L. Microbial monitoring and methods of sample collection: a GITMO survey (Gruppo Trapianto di Midollo Osseo). Ecancermedicalscience 2014; 8:421. [PMID: 24834116 PMCID: PMC3998655 DOI: 10.3332/ecancer.2014.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Indexed: 11/06/2022] Open
Abstract
The collection of microbiological samples represents an important aspect of care both for doctors as well as nurses. It is important to recognise and identify some key points, to avoid performing ‘unnecessary’ or ‘incorrect’ sampling, which may give useless or even misleading results, these are: the moment at which the sample is collected, the collection method and timing (if indicated). The comparison between the various nursing members of the Italian National bone marrow transplant group (GITMO), showed diversity of practice across all fields. A formal survey was therefore conducted within GITMO centres looking at the methods of microbiological sample collection. These results were compared with the literature, and in addition to the lack of homogeneity of practice within the centres, a lack of compliance with the recommendations was also observed. To evaluate the effectiveness of this survey in highlighting awareness of this issue and the presence of relevant guidelines, the questionnaire was repeated (with the same centres responding), which demonstrated no major changes in care practices.
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Affiliation(s)
- Erica Gori
- Institute of Haematology and Medical Oncology 'L&A Seragnòli', Bologna, Italy
| | | | - Francesca Alberani
- Institute of Haematology and Medical Oncology 'L&A Seragnòli', Bologna, Italy
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Ruiz Tovar J, Badia JM. Prevention of Surgical Site Infection in Abdominal Surgery. A Critical Review of the Evidence. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.cireng.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rubia-Ortí JEDL, Verdu-Trescolí G, Prado-Gascó V, Selvi-Sabater P, Firmino-Canhoto J. Taxa de contaminação de testes hematológicos e seus fatores determinantes. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo: Conhecer a taxa de contaminação de hemoculturas e os seus fatores determinantes. Métodos: Foram analisadas 564 amostras de hemoculturas requisitadas num serviço hospitalar de urgências e questionados 46 enfermeiras(os) durante um período de seis meses. Resultados: Produziram-se 92 contaminações de hemoculturas de um total de 564 requisições num período de seis meses, o que corresponde a uma taxa de contaminação de 16,31%. O fator determinante foi a utilização de técnica pouco estéril. Conclusão: A taxa de contaminação das hemoculturas está diretamente relacionada aos procedimentos utilizados pelos profissionais de enfermagem e a carga de trabalho está diretamente associada a erros na técnica estéril de coleta.
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[Prevention of surgical site infection in abdominal surgery. A critical review of the evidence]. Cir Esp 2014; 92:223-31. [PMID: 24411561 DOI: 10.1016/j.ciresp.2013.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/19/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
Surgical site infection (SSI) is associated with prolonged hospital stay, increased morbidity, mortality and sanitary costs, and reduced patients quality of life. Many hospitals have adopted guidelines of scientifically-validated processes for prevention of surgical site and central-line catheter infections and sepsis. Most of these guidelines have resulted in an improvement in postoperative results. A review of the best available evidence on these measures in abdominal surgery is presented. The best measures are: avoidance of hair removal from the surgical field, skin decontamination with alcoholic antiseptic, correct use of antibiotic prophylaxis (administration within 30-60 min before incision, use of 1(st) or 2(nd) generation cephalosporins, single preoperative dosis, dosage adjustments based on body weight and renal function, intraoperative re-dosing if the duration of the procedure exceeds 2 half-lives of the drug or there is excessive blood loss), prevention of hypothermia, control of perioperative glucose levels, avoid blood transfusion and restrict intraoperative liquid infusion.
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Steinhauer K, Meyer B, Ostermeyer C, Rödger HJ, Hintzpeter M. Hygienic safety of alcohol-based hand disinfectants and skin antiseptics. GMS HYGIENE AND INFECTION CONTROL 2013; 8:Doc19. [PMID: 24327945 PMCID: PMC3850229 DOI: 10.3205/dgkh000219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose: The aim of this study was to evaluate the overall risk of hand disinfectants and skin antiseptics to become contaminated with bacterial spores throughout the production process and the subsequent in-use period, hence posing a public health risk. Methods: Microbiological assessment of primary packaging material was carried out and long-term survival of bacterial spores in alcohol was assessed using sporulated B. subtilis ATCC 6633 as a standard. In-use contamination of alcohol-based formulations was tested by repeated use over 12 months under practical conditions and microbiological and physico-chemical data were determined. Results: Among 625 containers analyzed, 542 did not yield any microbial growth. Median colony count for aerobic spore-forming bacteria was 0.2 cfu/10 ml container content. No anaerobic spore-forming bacteria were detected. Additionally, long-term survival of bacterial spores in aliphatic C2–C3 alcohols revealed 1-propanol to reduce the number of spores most effectively, with 2-propanol and ethanol having a somewhat less pronounced impact. In-use tests did not detect any microbial contamination or change in the physicochemical properties of the tested products over 12 months. Conclusions: Our data reveals that state-of-the-art production processes of alcohol-based hand rubs and antiseptics can be regarded safe. Primary packaging material and use were not found to pose a significant contamination risk as far as bacterial spores are concerned. Based on the data from this study, a microbial limit of <1 cfu/10 ml can be suggested as a quality-control threshold for finished goods to ensure high quality and safe products.
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Levy PY, Ollivier M, Drancourt M, Raoult D, Argenson JN. Relation between nasal carriage of Staphylococcus aureus and surgical site infection in orthopedic surgery: the role of nasal contamination. A systematic literature review and meta-analysis. Orthop Traumatol Surg Res 2013; 99:645-51. [PMID: 23992764 DOI: 10.1016/j.otsr.2013.03.030] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/03/2013] [Accepted: 03/28/2013] [Indexed: 02/02/2023]
Abstract
UNLABELLED Staphylococcus aureus is the pathogen most frequently implicated in infection on orthopedic hardware; various strategies are deployed to limit the risk of transmission and surgical infection. OBJECTIVES The present study is based on a meta-analysis assessing firstly the relationship between nasal carriage of S. aureus and the development of osteo-articular infection and secondly current methods of decolonization. RESULTS The meta-analysis showed increased risk of surgical site infection in case of nasal carriage of S. aureus: OR=5.92, 95% CI [1.15-30.39]; P=0.033. For cross-transmission, a scientifically proven reduction in surgical site S. aureus levels is ensured by associated mupirocin and 2% chlorhexidine antiseptic solution in subjects with positive nasal screening results for all surgical procedures taken together; the reduction was not, however, significant in the orthopedic surgery subgroup. The meta-analysis confirmed these findings: OR=0.60, 95% CI [0.34-1.06]; P=0.08. CONCLUSION The literature review confirmed that nasal carriage of S. aureus is a major risk factor for surgical site infection. The efficacy of eradication could not be demonstrated for orthopedic surgery as samples were too small. The positive trend found, however, should encourage further studies with sufficient power and risk/benefit should meanwhile be assessed on a case-by-case basis. LEVEL OF EVIDENCE Level 2. Meta-analysis.
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Affiliation(s)
- P-Y Levy
- Pôle maladies infectieuses et tropicales, faculté de médecine, université de la Méditerranée, clinique biologique, 27, boulevard Jean-Moulin, 13385 Marseille, France
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