A Multi-Faceted Approach to Reduction of Blood Culture Contaminants at an Academic Medical Center

A Multi-Faceted Approach to Reduction of Blood Culture Contaminants at an Academic Medical Center

Background: Blood Culture Contaminants (BCC) lead to increased cost of care, prolonged length of stay and subject patients to unnecessary antimicrobial therapy.  Our hospital identified an absence of uniform education, lack of consistent collection technique and inadequate skin preparation.  A contaminant costs our facility $13,600.  We performed a retrospective and prospective study to determine an appropriate method to draw central line ordered blood cultures (BC):  through the needleless neutral displacement connector or hub-to-hub.

Objective: To educate staff, create a BC drawing protocol, identify staff on weekly reports, implement use of appropriate products for site cleansing and determine if drawing through the neutral displacement connector would reduce BCC from central lines.

Methods: Developed an accurate weekly report of BC drawn, educated staff on proper labeling of specimens and use of  employee identification number, involved Laboratory Technicians to ensure entering of employee identification numbers, created BC drawing protocol, developed and implemented a mandatory Phlebotomy for RNs class, switched to 2% chlorhexidine/alcohol product for site cleansing, aggressive remediation of staff who contaminated BC and created a BC Task Force,  representatives from each unit. Subsequent to those interventions, we performed a retrospective and prospective study to determine the most appropriate method to reduce BCC from central line draws: either through the needleless neutral displacement connector or by removing the connector and drawing hub-to-hub.  The study began on the Out-Patient Blood and Marrow Transplant Clinic for six months, extended to two adult intensive care units for six months then housewide for six months. 

Results: In 2006 the blood culture contamination rate was 6.96%.  With the implementation of our initial interventions, we saw our BCC rate fall to below the national standard of 3%.  In 2009, we created the BC Task Force and remediation became the responsibility of the Task Force.  We also began distributing the cost of contaminants to administration and individual unit managers.  In the first year of the study we saw a 48% reduction in BCC with a 62% reduction in BCC from central line draws. In the remaining six months of the housewide study, the hospital discontinued the Phlebotomy for RNs class; there we no additional interventions and we realized a reduction of BCC from central line drawn specimens of 34%. 

Conclusions: Utilizing aggressive education, implementing best practice and evidence based product changes we were able to reduce our BCC rates significantly and now have a threshold of 1.75%, which we have been able to achieve.  From 2006 to date this calculates to a reduction in nearly 800 BCC at our facility.