1
|
Neser E, Jung P, Halfmann A, Schröder M, Thurner L, Becker SL, Schneitler S. A multi-pronged approach to improve blood culture diagnostics in different clinical departments: a single-centre experience. Infection 2024; 52:183-195. [PMID: 37589812 PMCID: PMC10810936 DOI: 10.1007/s15010-023-02083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Blood culture (BC) diagnostics are influenced by many factors. We performed a targeted interdisciplinary analysis to analyse effects of various measures on BC diagnostics performance. METHODS A diagnostic stewardship initiative was conducted at two intervention and two control wards in a German tertiary level hospital. The initiative comprised staff training on the correct indications and sampling for BC, implementation of information cards, labels to identify the collection site, regular BC bottle feedback including the number of bottles, filling volumes and identified pathogens; and the use of a specific sampling device (BD Vacutainer®). Before and after the interventions, two three-month measurement periods were performed, as well as a one-month follow-up period to assess the sustainability of the conducted measures. RESULTS In total, 9362 BC bottles from 787 patients were included in the analysis. The number of BCs obtained from peripheral venous puncture could be increased at both intervention wards (44.0 vs. 22.2%, 58.3 vs. 34.4%), while arterial sampling could be reduced (30.6 vs. 4.9%). A total of 134 staff members were fully trained. The intervention led to a considerable increase in BC knowledge (from 62.4 to 79.8% correct answers) with differences between the individual professional groups. Relevant reduced contamination rates could be detected at both intervention wards. CONCLUSIONS As knowledge on the correct BC sampling and strategies to reduce contamination varies considerably between clinical departments and healthcare professionals, a targeted training should be adapted to the specific needs of the individual professional groups. An additional filling device is not necessary.
Collapse
Affiliation(s)
- Elisabeth Neser
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg/Saar, Germany
| | - Philipp Jung
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg/Saar, Germany
| | - Alexander Halfmann
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg/Saar, Germany
| | - Matthias Schröder
- Department of Anaesthesiology, Intensive Care and Analgesic Therapy, Saarland University, Homburg/Saar, Germany
| | - Lorenz Thurner
- Department of Internal Medicine Oncology, Haematology, Clinical Immunology and Rheumatology, Saarland University, Homburg/Saar, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg/Saar, Germany
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg/Saar, Germany.
- Clinic for Pneumology and Allergology, Bethanien Hospital, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany.
| |
Collapse
|
2
|
Povroznik MD. Initial Specimen Diversion Device Utilization Mitigates Blood Culture Contamination Across Regional Community Hospital and Acute Care Facility. Am J Med Qual 2022; 37:405-412. [PMID: 35353719 PMCID: PMC9426727 DOI: 10.1097/jmq.0000000000000055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A West Virginia regional community hospital incorporated an initial specimen diversion device (ISDD) into conventional blood culture protocol with the objective to bring the hospital-wide blood culture contamination (BCC) rate from a 3.06% preintervention rate to a target performance level below 1%. Emergency department staff, laboratory phlebotomists, and nursing staff on acute-critical care floors were trained on ISDD (Steripath Gen2, Magnolia Medical Technologies, Inc., Seattle, WA) operating procedure and utilized the device for blood culture sample collection with adult patients from September 2020 through April 2021. Of 5642 blood culture sets collected hospital-wide, 4631 were collected with the ISDD, whereas the remaining sets were collected via the conventional method. The ISDD BCC rate of 0.78% differed from the conventional method BCC rate of 4.06% observed during the intervention period (chi-squared test P < 0.00001). The ISDD group attained a sub-1% BCC rate to satisfy the intervention objective.
Collapse
Affiliation(s)
- Mark D. Povroznik
- Department of Quality, WVU Medicine: United Hospital Center, Bridgeport, WV
| |
Collapse
|
3
|
Impact of sterile gloves on blood-culture contamination rates: A randomized clinical trial. Am J Infect Control 2022; 50:49-53. [PMID: 34492326 DOI: 10.1016/j.ajic.2021.08.030] [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: 06/14/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Reducing the blood-culture contamination rate is a constant challenge for health services. This study aimed to analyze whether blood-culture (BC) collection using sterile gloves reduces the contamination rate when compared to the non-sterile gloves, and to compare baseline and intervention periods. METHODS A randomized clinical trial, performed in an intensive care unit in Brazil and paired in two groups: sterile (BCs obtained with modified sterile technique: only sterile gloves; no fenestrated drape or dedicated sterile collection kit) and clean (clean technique: usual care with non-sterile gloves). Two paired blood samples were obtained from each patient by trained and calibrated nurses. BCs were processed by conventional microbiological methods and the results were issued by blinded microbiologists. RESULTS There was no difference (P = 1.00) in the contamination rate of BC between the sterile (1%) and clean (1%) groups. However, there was a significant difference (P = 0.05; relative risk: 0.17; 95% confidence interval: 0.04-0.70) in the contamination rate between baseline (6.1%; 20/330) and intervention (1%; 2/200). CONCLUSIONS This study suggests that the aseptic care provided in obtaining samples is more important than the sterile technique itself, and highlights the value of standardizing the practices, qualification and calibration of phlebotomists.
Collapse
|
4
|
De Plato F, Fontana C, Gherardi G, Privitera GP, Puro V, Rigoli R, Viaggi B, Viale P. Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts. Clin Chem Lab Med 2020; 57:1680-1689. [PMID: 31348753 DOI: 10.1515/cclm-2018-1146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/24/2019] [Indexed: 12/23/2022]
Abstract
Bloodstream infections (BSIs) remain a potentially life-threatening condition. The gold standard for the diagnosis of BSI is still blood cultures (BCs), and the diagnostic yield depends on clinical and technical factors that have an impact on collection and transportation. Hence, monitoring of the entire pre-analytical process from blood collection to transportation to the microbiology laboratory is critical. To optimize the clinical impact of the diagnostic and therapeutic procedures, a multidisciplinary approach and univocal protocols are mandatory. A board of specialists discussed the available evidence on the pre-analytical process and produced the present document to guide physicians and nurses on the ideal execution of BC: (1) timing and preparation for blood collection; (2) skin antisepsis; (3) blood volume; (4) sampling method and safety; (5) medium to be used; (6) time to BC transportation; and (7) quality assurance and quality management.
Collapse
Affiliation(s)
- Francesca De Plato
- Società Italiana Farmacologia Ospedaliera, Milan, Italy; and Local Health Authority ASL of Teramo, Teramo, Italy
| | - Carla Fontana
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Microbiology and Virology Laboratory, Polyclinic of Tor Vergata, Rome, Italy
| | - Giovanni Gherardi
- Department of Medicine, Laboratory of Clinical Microbiology, University Campus Biomedico, Rome 00128, Italy
| | - Gaetano Pierpaolo Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,University Hygiene and Epidemiology Complex Operative Unit and Clinical Risk Functional Area Coordinator, University Hospital Pisana, Pisa, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Roberto Rigoli
- Department of Clinical Pathology, Local Health and Social Care Facility, No. 2, Marca Trevigiana, Treviso, Italy
| | - Bruno Viaggi
- Neuroanesthesia and Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
5
|
Hemeg HA, Almutairi AZ, Alharbi NL, Alenezi RF, Alturkostani MA, Ozbak HA, Islam FA. Blood culture contamination in a tertiary care hospital of Saudi Arabia. A one-year study. Saudi Med J 2020; 41:508-515. [PMID: 32373918 PMCID: PMC7253833 DOI: 10.15537/smj.2020.5.25052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To monitor blood culture contamination (BCC) rates in a tertiary care hospital in Saudi Arabia. Methods: Blood cultures submitted to the Microbiology Laboratory of King Fahad Hospital, Madina, Saudi Arabia between January and December 2017 were analyzed prospectively. Positive blood cultures were either designated as true bacteremia with confirmed bloodstream infection or BCC. Results: Among 5,536 blood cultures from 2201 patients, 364 (6.6%) mirrored BCC. There was an upward trend in contamination rates in specific months. With respect to total blood cultures from respective units over a one-year period, medical ward contributed to the highest contamination rate (10.3%). Blood culture contamination rate in the wards ranged from 4.5-10.3%, with a higher contamination rate in elderly, aged 60-80 years. Staphylococcus epidermidis (S. epidermidis) was the most frequent contaminant (44.5%). Conclusion: The escalated contamination rates in September to October may be attributed to difficulty in sampling blood by the less competent nurses during annual pilgrimage season. High influx of patients and shortage of trained nurses may have resulted in increased incidence in December-January and March-April. The prevalence of skin-resident S. epidermidis may be due to improper aseptic conditions. Ours is the first report on evaluation of BCC rates in Madina and call for renewed efforts in this direction.
Collapse
Affiliation(s)
- Hassan A Hemeg
- Department of Medical Laboratories Technology, Faculty of Applied Medical Sciences, Taibah University, Madina, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | | | |
Collapse
|
6
|
Al-Hamad AM. Successful Reduction of Blood Culture Contamination in an Emergency Department by Monitoring and Feedback. Open Microbiol J 2019. [DOI: 10.2174/1874285801913010279] [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
Background:Blood Culture (BC) contamination is a common problem in the Emergency Department (ED) and is associated with prolonged length of patient stay and excess costs.Objective:The study aimed to investigate the impact of monthly monitoring and feedback of BC results on contamination rates.Methods:Data from a previous study showed that the contamination rate in the ED consistently exceeded the recommended level. This triggered an ad hoc Quality Improvement team to develop and implement a corrective action plan. In 2017, BC contamination rates were reported to the ED on a monthly basis. In response to this, ED staff conducted intensified educational workshops, followed by private counselling and competency assessment of nurses who collected contaminated BCs.Results:A total of 12 educational workshops were conducted in February and March, 2017. The intervention resulted in >60% reduction in the contamination rate, from 8.6% baseline level to less than 3%. Of the 2660 BC sets drawn in 2017 from 1318 patients, 128 (4.8%) were contaminated, accounting for 39.5% of the total number of positive cultures. Sixty percent of the contaminated BCs grew Coagulase-negativeStaphylococcusspecies; other contaminants includedCorynebacteriumspp.,Micrococcusspp.,Propionibacteriumspp.,viridansStreptococcus, andNeisseriaspp.Conclusion:Continuous monitoring and feedback of contamination rates reduced BC contamination.
Collapse
|
7
|
Zaleski M, Erdman P, Adams J, Michael A, Rudy A, Boesch R, Allison L, Mailander P, Hess W, Myers D, Craft D. Establishing a Long-Term Model for Analysis and Improvement of Underfilled Blood Culture Volumes. Am J Clin Pathol 2019; 151:164-170. [PMID: 30260386 DOI: 10.1093/ajcp/aqy125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives Underfilling of blood culture bottles decreases the sensitivity of the culture. We attempt to increase average blood culture fill volumes (ABCFVs) through an educational program. Methods Partnerships were established with four hospital units (surgical intensive care unit [SICU], medical intensive care unit [MICU], medical intermediate care unit [MIMCU], and hematology and oncology unit [HEME/ONC]). ABCFVs were continuously tracked and communicated to each unit monthly. Educational sessions were provided to each unit. Results ABCFVs for the SICU, MICU, MIMCU, and HEME/ONC were 4.8, 5.0, 5.0, and 6.3 mL/bottle, respectively. After the final education session, the SICU, MICU, MIMCU, and HEME/ONC were able to maintain an ABCFV of 6.8, 8.1, 7.9, and 8.2 mL/bottle, respectively. Conclusions Partnering with a specific unit and providing monthly volume reports with educational sessions has a direct positive correlation on increasing ABCFVs. Increasing ABCFVs has the potential to decrease false-negative blood cultures, time to detection of positive blood cultures, and time to appropriate and specific antimicrobial therapy, as well as improve patient outcomes in high-acuity patient care units.
Collapse
Affiliation(s)
- Michael Zaleski
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Patrick Erdman
- Memorial Sloan Kettering Cancer Center, Department of Laboratory Medicine, New York, NY
| | - Joshua Adams
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Amanda Michael
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Abigail Rudy
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Robert Boesch
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Lauren Allison
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | - Wendell Hess
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Debra Myers
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - David Craft
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| |
Collapse
|
8
|
Bell M, Bogar C, Plante J, Rasmussen K, Winters S. Effectiveness of a Novel Specimen Collection System in Reducing Blood Culture Contamination Rates. J Emerg Nurs 2018; 44:570-575. [DOI: 10.1016/j.jen.2018.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/30/2017] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
|
9
|
El Feghaly RE, Chatterjee J, Dowdy K, Stempak LM, Morgan S, Needham W, Prystupa K, Kennedy M. A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children's Hospital. Pediatrics 2018; 142:peds.2018-0244. [PMID: 30217808 DOI: 10.1542/peds.2018-0244] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Blood culture contamination is a safety and quality concern in children's hospitals; it leads to increased unnecessary testing, admissions, antibiotic exposure, and cost. The standard benchmark for blood culture contamination is 3%. Our aim with the quality improvement project was to reduce the contamination rate at our children's hospital from a mean of 2.85% to <1.5% in 2 years. METHODS After initial unit-specific efforts, we formed a multidisciplinary team, created a process map and a cause-and-effect analysis, sent out surveys to nurses, and created observation sheets used to identify problem areas and record the most common deviations during the collection process. We also standardized the blood culture collection protocol and reemphasized nurse education in person and with online modules. During our project, we noted that nurses were collecting 1 to 3 mL of blood on all children regardless of weight. We developed optimal weight-based blood volumes and, after educating ordering providers, we updated our electronic medical record to reflect appropriate volumes in the order. RESULTS Despite a steady increase in the number of blood cultures collected at our children's hospital, we were able to decrease the average contamination rate from 2.85% to 1.54%, saving the hospital an estimated average of $49 998 per month. CONCLUSIONS By standardizing blood culture collection methods, optimizing blood volume, creating checklists, and reinforcing nurse education, we were able to develop a best practice for pediatric blood culture collection and reduce blood culture contamination to a sustainable low rate at our children's hospital.
Collapse
Affiliation(s)
| | | | | | | | - Stephanie Morgan
- Children's of Mississippi Laboratory, University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | | |
Collapse
|
10
|
Ao W, Clifford A, Corpuz M, Jenison R. A novel approach to eliminate detection of contaminating Staphylococcal species introduced during clinical testing. PLoS One 2017; 12:e0171915. [PMID: 28225823 PMCID: PMC5321469 DOI: 10.1371/journal.pone.0171915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/27/2017] [Indexed: 01/28/2023] Open
Abstract
We describe here a strategy that can distinguish between Staphylococcus species truly present in a clinical sample from contaminating Staphylococcus species introduced during the testing process. Contaminating Staphylococcus species are present at low levels in PCR reagents and colonize lab personnel. To eliminate detection of contaminants, we describe an approach that utilizes addition of sufficient quantities of either non-target Staphylococcal cells (Staphylococcus succinus or Staphylococcus muscae) or synthetic oligonucleotide templates to helicase dependent isothermal amplification reactions to consume Staphylococcus-specific tuf and mecA gene primers such that contaminating Staphylococcus amplification is suppressed to below assay limits of detection. The suppressor template DNA is designed with perfect homology to the primers used in the assay but an internal sequence that is unrelated to the Staphylococcal species targeted for detection. Input amount of the suppressor is determined by a mathematical model described herein and is demonstrated to completely suppress contaminating levels of Staphylococcus while not negatively impacting the appropriate clinical assay limit of detection. We have applied this approach to improve the specificity of detection of Staphylococcus species present in positive blood cultures using a chip-based array that produces results visible to the unaided eye.
Collapse
Affiliation(s)
- Wanyuan Ao
- Great Basin Corporation, Salt Lake City, Utah, United States of America
| | - Adrianne Clifford
- Great Basin Corporation, Salt Lake City, Utah, United States of America
| | - Maylene Corpuz
- Great Basin Corporation, Salt Lake City, Utah, United States of America
| | - Robert Jenison
- Great Basin Corporation, Salt Lake City, Utah, United States of America
- * E-mail:
| |
Collapse
|