Decreasing Blood Culture Contamination Rates in the Emergency Department (ED) and Urgent Care Centers

Purpose:
Early in 2008 we identified that our ED and Urgent Care Centers (2) had a greater rate of contaminated blood cultures compared to a national benchmark. Our goal was to determine where contaminants were being introduced and identify a practice change that would lead to an overall rate decrease.

Significance:
Contamination in blood cultures can lead to return visits to the ED, increased cost to family and hospital, possible admission due to tainted results, and unnecessary administration of antibiotics and family anxiety. Also, repeated labs for another blood culture costs $103 and 40 minutes staff time.

Strategy and Implementation:
Retrospective data regarding the total number of cultures and total number of contaminated cultures was gathered. Current nursing practice was explored through interview and direct observation and evaluated step-by-step through flow diagrams to identify potential entry for contaminates in the current collection process. Our practice involved drawing blood cultures simultaneously with other lab work when placing an IV. Pre-intervention process was changed to eliminate potential entry points for contaminates by ensuring proper cleaning of blood culture bottles, proper disinfection of the collection site and a separate venipuncture from the IV placement using a closed collection system. We set a goal of less than 4% contamination rate based on benchmarking with other hospitals. ED RNs were then educated in the new process and procedure for blood culture collection. Physicians were alerted of the change in practice in order to assist in the preparation of the families for the procedure.

Evaluation:
The intervention is analyzed monthly by collecting data (total cultures, positives and contamination rate) from lab (pre-intervention high: 11.38%, post-intervention high: 3.18%). Spikes above 4% are investigated by the ED leadership to evaluate educational opportunities and practice variation.

Implications for Practice:
Using rapid cycle improvement, nursing practice changes in how samples are obtained can lead to lower contamination improving patient satisfaction and quality. An added benefit was the intervention led to lower blood culture volume as physicians reviewed other results before ordering cultures.