Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study.

Self WH, Speroff T, Grijalva CG, McNaughton CD, Ashburn J, Liu D, Arbogast PG, Russ S, Storrow AB, Talbot TR
Acad Emerg Med. 2013 20 (1): 89-97

PMID: 23570482 · PMCID: PMC3623801 · DOI:10.1111/acem.12057

OBJECTIVES - Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED.

METHODS - The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university-affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48-week baseline period (clean technique) and 48-week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first-order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%.

RESULTS - During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period.

CONCLUSIONS - A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.

© 2013 by the Society for Academic Emergency Medicine.

MeSH Terms (12)

Antisepsis Blood Blood Specimen Collection Chlorhexidine Emergency Service, Hospital Equipment Contamination Female Humans Male Prospective Studies Quality Improvement United States

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