Blood Culture Contamination: How Low Can You Go?

Purpose:
The Emergency Department Quality Triad's main objective was to develop a program which decreased blood culture contamination rates to 2.9% or below and foster a sense of ownership.

Relevance/Significance:
Blood cultures are the gold standard by which bacteremia is detected. Specimen contamination contributes to increased lengths of stay, unnecessary testing and treatment, and increased costs to the patient and institution. Blood culture contamination may adversely impact patient outcome.

Strategy and Implementation:
The department's quality triad, recognized blood culture contamination rates exceeded the national benchmark. The triad partnered with the clinical nurse specialist and formed a multidisciplinary team to develop a sustainable process. After completing a review of literature, evidence based best practices, and data, the team concluded that most effective way to decrease contamination was to identify and train a select group of staff members to obtain the blood cultures. The laboratory supervisor and the learning specialist provided education to all staff regarding the new process. The nursing assistants and paramedics underwent additional didactic education and were required to successfully complete a skills performance evaluation. All new team members receive this training during unit orientation. Weekly contamination reports are shared with staff and administration. The employee that obtained the contaminated blood culture is included in a review and undergoes additional training.

Evaluation:
Prior to implementing this project, contamination rates ranged from 6.4% to 1.2% with a baseline average of 3.2%. Rates below the 2.9% goal were not sustained longer than one month. Post implementation blood culture contamination rates have decreased to a monthly average 1% with a range of 0.43% to 2%. This data is shared with the staff.

Implications for Practice:
Involving the end user in the improvement project led to staff ownership and was a key factor in the sustainability of this new culture. This has led the way for additional projects for the triad and has increased staff involvement in other initiatives.