Reduction of Blood Culture Contamination in an Emergency Department
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The Emergency Department experienced a steady increase in their blood culture contamination rate. The benchmark set for blood culture contamination is ≤2% The purpose of this project was to reduce the blood culture contamination rate for the ED.
Relevance/Significance:
In 2012 there were 204 contaminated specimens. One contaminated specimen costs approximately $8,000 which means that we could have avoided $1,632,000 in costs. In 2013, with 180 contaminated specimens we could have avoided $1,440,000 in costs.
Strategy and Implementation:
In April 2014 task force was developed to address the issue. The team was multidisciplinary. After a gap analysis of the consultant's recommendations, the team systematically instituted every recommendation for two months while tracking the blood culture contamination rates. In July 2014, two additional actions were added to the gap analysis. The first required staff to wear sterile gloves when obtaining blood cultures. The second required the lab director to send a list of potentially contaminated blood cultures immediately upon the final result as opposed to waiting until the end of the month. The staff member(s) responsible for collection of the blood culture(s) participate in a cause analysis to determine any areas of improvement. The 2014 average rate for the ED was 2.83% and the facility average rate was 1.83%. The team reached their goal of a blood culture contamination rate less than or equal to 2%.
Evaluation:
The facility saw a substantial reduction in contaminated specimens after implementation of sterile gloves and timely feedback from the lab. In 2014, we had 100 contaminated specimens. This reduction allowed us to decrease cost by 44% ($800,000 in costs related to contaminated blood cultures).
Implications for Practice:
The benefits, realized from the improved process, for our patients include significant decrease in patient harm, reduced costs, reduced length of stay, reduction of unnecessary antibiotic administration and reduction in waste of other resources (time, staff, etc.).