Reduction of Blood Culture Contaminations in the Emergency Department

Background: Contaminations of blood cultures are a common problem in the Emergency Department, ranging up to 10% on admitted patients.  This can lead to increased length of stay, increased morbidity and mortality, and increased costs to the hospital.  Our hospital identified a lack of knowledge, varying skin preparation practices, and lack of nurse feedback as possibilities for our high contamination rate. 

Objective: The objectives of this project were to educate staff, reduce the potential for different practices and provide individual feedback in order to reduce our blood culture contamination rate.

Methods: Nurses at two Emergency Departments in the same hospital system were given instructions on proper blood culture collection.  During this instruction period, we identified variations in cleansing practice and made a decision to standardize to one cleansing product: Chloraprep®.  Each month, the blood culture contaminations were provided by our clinical laboratory.  This data was used to pull charts and provide individual feedback to the nurses.  Information learned during the process was shared at staff meetings bi-monthly.  At the end of one year, staff with zero contaminations were formally recognized for their success.

Results: In a nine month period both Emergency Departments have reduced and maintained their blood culture contamination rate from 10% to 3%.  Each month as contaminations were reviewed with nurses, information was gathered as to best practice.  Cleansing the site for the manufacturer’s prescribed time and not re-palpating with a non-sterile or unclean glove were two of the components that we determined to be best practice.  By reducing the contamination rate, we potentially reduced the need for a re-draw three days later and therefore, decrease length of stay, decrease morbidity and mortality and decrease costs.

Conclusions: With proper education, utilizing best practice, and giving individual constructive and positive feedback, we were able to reduce our blood culture contamination rates in our Emergency Departments.  Previous studies estimate blood culture contamination costs per patient to be in excess of $5,000.00.  In our estimation, we saved approximately 500 blood cultures from being contaminated resulting in cost savings of $2,500,000.00.  We recommend Emergency Departments with high blood culture contaminations review their practices and utilize these simple changes to reduce costs, morbidity and mortality.