Using Shared Governance to Reduce Blood Culture Contamination Rates in the Emergency Department

Purpose:
Monthly blood culture contamination rates were above and just below the national benchmark of 3% in our Emergency Department. Our goal was to decrease and maintain the rates to less than 2% using shared governance and innovative strategies for this evidence based practice change.

Significance:
Healthcare providers rely heavily on blood culture results for developing the patient's plan of care. Contaminated blood culture specimens can have a significant negative impact on patients and the healthcare system, which include unnecessary treatment, increased length of stay and increased costs.

Strategy and Implementation:
Prior to this initiative, our facility's policy included preparing the collection site for 3 minutes. After reviewing the literature, it was clear that a procedure that is feasible in the fast paced Emergency Department and ensures maximum efficacy of the chlorhexidine for site prep is essential. Based on the evidence, the new procedure included a 30 second scrub and 30 second dry time for site preparation and the use of a sterile drape to keep the area clean, not sterile. In order to objectively ensure that proper timing would be used, each staff member was given a 30 second sand timer to use for each step of the procedure. Take a minute to make a difference, 30 x 2! The Emergency Department Shared Governance Committees, Education and Performance Improvement, shared responsibility by educating the staff, which included a 20 minute PowerPoint presentation with return demonstration, and monitoring compliance via random audits. Weekly contamination rates were posted in the lounge.

Evaluation:
During the 8 week pilot, the monthly contamination rates were 1.96% and 0.3%, respectively. Over a 29 day period, the staff collected over 600 specimens with no contaminations. Data collected after the initial pilot revealed that the contamination rates remained below the target, less than 2%

Implications for Practice:
This quality improvement initiative provides evidence that Shared Governance Committees can be effective for implementing an evidence-based practice change. Developing a plan that is evidence-based and feasible in the fast paced Emergency Department can help ensure the delivery of high quality care