Reducing Blood Culture Contamination in the ED for Patients with Fever: A Nursing and Lab Collaboration
Main Article Content
Keywords
blood culture contamination, emergency department, fever, nursing, laboratory, collaboration
Abstract
Blood culture contamination is a significant problem in emergency departments (EDs), leading to unnecessary antibiotic use, prolonged hospital stays, and increased healthcare costs. This article explores strategies for reducing blood culture contamination rates in febrile patients through an interdisciplinary approach involving nursing and laboratory staff. Key interventions include implementing standardized blood culture collection protocols, providing ongoing staff education and training, using dedicated phlebotomy teams, and leveraging rapid diagnostic technologies. By fostering effective communication and establishing clear roles and responsibilities, EDs can improve the accuracy of blood culture results, optimize patient care, and reduce the burden of contamination.
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Bentley, J., Thakore, S., Muir, L., Baird, A., & Lee, J. (2016). A change of culture: reducing blood culture contamination rates in an Emergency Department. BMJ Quality Improvement Reports, 5(1), u206760.w2754.
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Caldeira, D., David, C., & Sampaio, C. (2011). Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. Journal of Hospital Infection, 77(3), 223-232.
Clinical and Laboratory Standards Institute. (2007). Principles and procedures for blood cultures: approved guideline. Clinical and Laboratory Standards Institute.
Dawson, S. (2014). Blood culture contaminants. Journal of Hospital Infection, 87(1), 1-10.
Denno, J., & Gannon, M. (2013). Practical steps to lower blood culture contamination rates in the emergency department. Journal of Emergency Nursing, 39(5), 459-464.
Elantamilan, D., Lyngdoh, V. W., Khyriem, A. B., Rajbongshi, J., Sidhwa, T. B., & Marbaniang, E. (2016). Comparative evaluation of the role of single and multiple blood specimens in the outcome of blood cultures using BacT/ALERT 3D (automated) blood culture system in a tertiary care hospital. Indian Journal of Critical Care Medicine, 20(9), 530.
Gander, R. M., Byrd, L., DeCrescenzo, M., Hirany, S., Bowen, M., & Baughman, J. (2009). Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. Journal of Clinical Microbiology, 47(4), 1021-1024.
Herasevich, V., Fischer, G. A., Lababidi, N., Hanson, A. C., & Barwise, J. A. (2020). Root cause analysis of blood culture contamination in the emergency department identifies multiple nurse-related causes and a lack of communication between providers. Journal of Patient Safety, 16(2), e111-e115.
Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6-14.
Kite, B., Jensen, D., & Mearkle, R. (2021). Blood culture quality improvement in the emergency department: Using technology and staff engagement to drive change. Journal of Emergency Nursing, 47(2), 213-219.
Lambregts, M. M., Bernards, A. T., van der Beek, M. T., Visser, L. G., & de Boer, M. G. (2019). Time to positivity of blood cultures supports early re-evaluation of empiric broad-spectrum antimicrobial therapy. PloS One, 14(1), e0208819.
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Rabello Filho, R., Rocha, L. L., Corrêa, T. D., Pessoa, C. M. S., Colombo, G., & Assuncao, M. S. C. (2016). Blood lactate levels cutoff and mortality prediction in sepsis—time for a reappraisal? A retrospective cohort study. Shock, 46(5), 480-485.
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Self, W. H., Speroff, T., Grijalva, C. G., McNaughton, C. D., Ashburn, J., Liu, D., ... & Talbot, T. R. (2013). Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Academic Emergency Medicine, 20(1), 89-97.
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Sloane, P. D., Ward, K., Weber, D. J., Kistler, C. E., Brown, B., Davis, K., & Zimmerman, S. (2018). Can sepsis be detected in the nursing home prior to the need for hospital transfer?. Journal of the American Medical Directors Association, 19(6), 492-496.
Snyder, S. R., Favoretto, A. M., Baetz, R. A., Derzon, J. H., Madison, B. M., Mass, D., ... & Liebow, E. B. (2012). Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis. Clinical Biochemistry, 45(13-14), 999-1011.
Tarai, B., Jain, D., Das, P., & Budhiraja, S. (2018). Paired blood cultures increase the sensitivity for detecting pathogens in both inpatients and outpatients. European Journal of Clinical Microbiology & Infectious Diseases, 37(3), 435-441.
Timbrook, T. T., Morton, J. B., McConeghy, K. W., Caffrey, A. R., Mylonakis, E., & LaPlante, K. L. (2017). The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clinical Infectious Diseases, 64(1), 15-23.
Torsvik, M., Gustad, L. T., Mehl, A., Bangstad, I. L., Vinje, L. J., Damås, J. K., & Solligård, E. (2016). Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Critical Care, 20(1), 244.
Vijayan, A. L., Vanimaya, Ravindran, S., Saikant, R., Lakshmi, S., Kartik, R., & G, M. (2017). Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. Journal of Intensive Care, 5(1), 51.
Virk, H. U. H., De Leon, S., Chatterjee, A., Delacruz, G., Majid, R., Layman, A., ... & Alam, M. (2019). Reducing blood culture contamination using a dedicated phlebotomy team in the emergency department. The Journal of Emergency Medicine, 57(4), 493-500.
Weinstein, M. P., Towns, M. L., Quartey, S. M., Mirrett, S., Reimer, L. G., Parmigiani, G., & Reller, L. B. (1997). The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clinical Infectious Diseases, 24(4), 584-602.
Wilson, M. L., & Morris, A. (2007). Principles and procedures for blood cultures; approved guideline. Clinical and Laboratory Standards Institute.
Banerjee, R., Teng, C. B., Cunningham, S. A., Ihde, S. M., Steckelberg, J. M., Moriarty, J. P., ... & Patel, R. (2015). Randomized trial of rapid multiplex polymerase chain reaction–based blood culture identification and susceptibility testing. Clinical Infectious Diseases, 61(7), 1071-1080.
Bekeris, L. G., Tworek, J. A., Walsh, M. K., & Valenstein, P. N. (2005). Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Archives of Pathology & Laboratory Medicine, 129(10), 1222-1225.
Bentley, J., Thakore, S., Muir, L., Baird, A., & Lee, J. (2016). A change of culture: reducing blood culture contamination rates in an Emergency Department. BMJ Quality Improvement Reports, 5(1), u206760.w2754.
Bowen, C. M., Coleman, T., & Cunningham, D. (2016). Reducing blood culture contamination rates in the emergency department: A quality improvement project employing an interdisciplinary team approach. Journal of Emergency Nursing, 42(4), 306-311.
Caldeira, D., David, C., & Sampaio, C. (2011). Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. Journal of Hospital Infection, 77(3), 223-232.
Clinical and Laboratory Standards Institute. (2007). Principles and procedures for blood cultures: approved guideline. Clinical and Laboratory Standards Institute.
Dawson, S. (2014). Blood culture contaminants. Journal of Hospital Infection, 87(1), 1-10.
Denno, J., & Gannon, M. (2013). Practical steps to lower blood culture contamination rates in the emergency department. Journal of Emergency Nursing, 39(5), 459-464.
Elantamilan, D., Lyngdoh, V. W., Khyriem, A. B., Rajbongshi, J., Sidhwa, T. B., & Marbaniang, E. (2016). Comparative evaluation of the role of single and multiple blood specimens in the outcome of blood cultures using BacT/ALERT 3D (automated) blood culture system in a tertiary care hospital. Indian Journal of Critical Care Medicine, 20(9), 530.
Gander, R. M., Byrd, L., DeCrescenzo, M., Hirany, S., Bowen, M., & Baughman, J. (2009). Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. Journal of Clinical Microbiology, 47(4), 1021-1024.
Herasevich, V., Fischer, G. A., Lababidi, N., Hanson, A. C., & Barwise, J. A. (2020). Root cause analysis of blood culture contamination in the emergency department identifies multiple nurse-related causes and a lack of communication between providers. Journal of Patient Safety, 16(2), e111-e115.
Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6-14.
Kite, B., Jensen, D., & Mearkle, R. (2021). Blood culture quality improvement in the emergency department: Using technology and staff engagement to drive change. Journal of Emergency Nursing, 47(2), 213-219.
Lambregts, M. M., Bernards, A. T., van der Beek, M. T., Visser, L. G., & de Boer, M. G. (2019). Time to positivity of blood cultures supports early re-evaluation of empiric broad-spectrum antimicrobial therapy. PloS One, 14(1), e0208819.
Menon, V., Lahanas, S., Janto, C., Ong, E., & Lee, W. L. (2018). Utility of electronic medical record alerts to reduce blood culture contamination in the emergency department. Journal of Hospital Infection, 100(1), 11-15.
Powell, S. (2017). Sepsis guidelines and diagnostics: current impact and future outlook. Medical Laboratory Observer, 49(8), 30-33.
Rabello Filho, R., Rocha, L. L., Corrêa, T. D., Pessoa, C. M. S., Colombo, G., & Assuncao, M. S. C. (2016). Blood lactate levels cutoff and mortality prediction in sepsis—time for a reappraisal? A retrospective cohort study. Shock, 46(5), 480-485.
Ramirez, P., Gordón, M., Cortes, C., Villarreal, E., Perez-Belles, C., Robles, C., ... & Bonastre, J. (2015). Blood culture contamination rate in an intensive care setting: Effectiveness of an education-based intervention. American Journal of Infection Control, 43(8), 844-847.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., ... & Dellinger, R. P. (2017). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine, 43(3), 304-377.
Self, W. H., Talbot, T. R., Paul, B. R., Collins, S. P., & Ward, M. J. (2014). Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams. Infection Control & Hospital Epidemiology, 35(8), 1021-1028.
Self, W. H., Speroff, T., Grijalva, C. G., McNaughton, C. D., Ashburn, J., Liu, D., ... & Talbot, T. R. (2013). Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Academic Emergency Medicine, 20(1), 89-97.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801-810.
Sloane, P. D., Ward, K., Weber, D. J., Kistler, C. E., Brown, B., Davis, K., & Zimmerman, S. (2018). Can sepsis be detected in the nursing home prior to the need for hospital transfer?. Journal of the American Medical Directors Association, 19(6), 492-496.
Snyder, S. R., Favoretto, A. M., Baetz, R. A., Derzon, J. H., Madison, B. M., Mass, D., ... & Liebow, E. B. (2012). Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis. Clinical Biochemistry, 45(13-14), 999-1011.
Tarai, B., Jain, D., Das, P., & Budhiraja, S. (2018). Paired blood cultures increase the sensitivity for detecting pathogens in both inpatients and outpatients. European Journal of Clinical Microbiology & Infectious Diseases, 37(3), 435-441.
Timbrook, T. T., Morton, J. B., McConeghy, K. W., Caffrey, A. R., Mylonakis, E., & LaPlante, K. L. (2017). The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clinical Infectious Diseases, 64(1), 15-23.
Torsvik, M., Gustad, L. T., Mehl, A., Bangstad, I. L., Vinje, L. J., Damås, J. K., & Solligård, E. (2016). Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Critical Care, 20(1), 244.
Vijayan, A. L., Vanimaya, Ravindran, S., Saikant, R., Lakshmi, S., Kartik, R., & G, M. (2017). Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. Journal of Intensive Care, 5(1), 51.
Virk, H. U. H., De Leon, S., Chatterjee, A., Delacruz, G., Majid, R., Layman, A., ... & Alam, M. (2019). Reducing blood culture contamination using a dedicated phlebotomy team in the emergency department. The Journal of Emergency Medicine, 57(4), 493-500.
Weinstein, M. P., Towns, M. L., Quartey, S. M., Mirrett, S., Reimer, L. G., Parmigiani, G., & Reller, L. B. (1997). The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clinical Infectious Diseases, 24(4), 584-602.
Wilson, M. L., & Morris, A. (2007). Principles and procedures for blood cultures; approved guideline. Clinical and Laboratory Standards Institute.
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Published
Apr 17, 2022
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Monahi nasser alyami, Haya saeed alqorbi, Muneera saeed alshahrani, Njoud Saeed Mohammed Alasmari, Shareefah mobark alasmari, Muneera saeed alshahrani, A. N. A. M. M. M. A. M. N. A. S. S. M. A. M. M. A. A. inazi, S. M. A. (2022). Reducing Blood Culture Contamination in the ED for Patients with Fever: A Nursing and Lab Collaboration. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 921–928. https://doi.org/10.53555/jptcp.v29i04.5590
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