Reducing Blood Culture Contamination in the Emergency Department: An Interrupted Time Series Quality Improvement Study. (13th January 2013)

• Record Type: Journal Article
• Authors: Self, Wesley H.; Speroff, Theodore; Grijalva, Carlos G.; McNaughton, Candace D.; Ashburn, Jacki; Liu, Dandan; Arbogast, Patrick G.; Russ, Stephan; Storrow, Alan B.; Talbot, Thomas R.; Lewis, Lawrence M.
• Is Part Of: Academic emergency medicine. Volume 20:Number 1(2013:Jan.)
• Page Start: 89
• Page End: 97
• Publication Date: 2013-01-13
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12057
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" id="acem12057-abs-0001"> <title>Abstract</title> <sec id="acem12057-sec-0001" sec-type="section"> <title>Objectives</title> <p>Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED.</p> </sec> <sec id="acem12057-sec-0002" sec-type="section"> <title>Methods</title> <p>The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university‐affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48‐week baseline period (clean technique) and 48‐week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first‐order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%.</p> </sec> <sec id="acem12057-sec-0003" sec-type="section"> <title>Results</title> <p>During the baseline period, 321 of 7, 389 (4.3%) cultures were contaminated, compared to 111 of 6, 590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period.</p> </sec> <sec id="acem12057-sec-0004" sec-type="section"> <title>Conclusions</title> <p>A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.</p> </sec> </abstract>