2.50
Hdl Handle:
http://hdl.handle.net/10755/162677
Type:
Presentation
Title:
Decreasing Blood Culture Contamination Rates in a Pediatric Emergency Room
Abstract:
Decreasing Blood Culture Contamination Rates in a Pediatric Emergency Room
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Sullivan, Kathlyn, RN, BSN
P.I. Institution Name:Alfred I. DuPont Hospital for Children
Title:Registered Nurse
Contact Address:1600 Rockland Rd., Wilmington , DE, 19803, USA
Contact Telephone:302-651-6282
Co-Authors:Deena Brecher, RN, MSN, CEN, APRN, BC
[Clinical Poster] Clinical Topic: False positive blood cultures, defined as cultures contaminated with bacteria external to the patient, can result in increased lengths of stay and higher cost of treatment. Because this is a pediatric emergency department (ED), it is important to staff, parents, and patients that we collect blood culture samples during intravenous (IV) catheter insertion when possible, rather than from venipuncture, to minimize distress in the child. However, collecting samples in this way is known to result in higher contamination rates. In April 2004, the monthly contamination rate of blood culture samples (most of them drawn during IV insertion), was 8%, significantly higher than the nationally accepted average of 3% to 5%, as defined by the American Society for Microbiology. A subsequent review of staff practices revealed inconsistent compliance with recommended blood culture collection techniques. An education campaign was therefore implemented, with the goal of bringing contamination rates in line with the national average, even for samples collected during IV catheter insertion.

Implementation: This ongoing project, implemented in August 2004, was conducted in the emergency department of a 180-bed freestanding children's hospital in the Northeast that treats approximately 35,000 patients per year and obtains 30% to 40% of the institution's blood cultures. The education campaign, headed by the clinical nurse specialist, reinforced correct skin preparation and strategies to reduce contamination in the emergency department. The techniques were not new; skin preparation for drawing a blood culture specimen is standardized house-wide, and calls for using a Frepp sponge and Betadine swab. All registered nurses and technicians received retraining in the form of hands-on opportunities and written material, either one-to-one or in small groups. Written policies for obtaining blood samples were reviewed and staff practiced technique on a mannequin. Retraining of the entire staff (including part-time and casual employees) took approximately two months to complete. Staff performance was monitored for a six-month period following reeducation, using medical record documentation. For the first confirmed contaminant, the individual received an email warning; for the second, the staff member reviewed proper technique with the clinical nurse specialist; the third required return demonstration of correct technique with skin preparation and equipment set-up; and the fourth required direct supervision of specimen collection.

Outcomes: From the start of the program in August 2004, through November 2005, ED blood culture contamination rates declined from 8% to under 3%, for all but 3 months, (possibly due to changes in staff and equipment). For the six-month post-training period, four nurses required review of proper technique with the clinical nurse specialist. As of May 2006, the contamination rate dropped to 2.2%, where it remains to date. Because we attained our goal of reducing contamination rates to below 3%, the emergency department continues to routinely draw blood cultures during IV catheter insertion, which has increased staff, patient, and family satisfaction. Although staff and family satisfaction were not formally surveyed, the general consensus among staff is to keep the number of venipunctures to a minimum, a desire parents frequently express. Contamination rates continue to be measured monthly by laboratory staff and tracked closely by the ED nurse manager, clinical nurse specialist, and a staff registered nurse, responsible for compiling data. Individual follow up also continues with results shared in hospital quality improvement committees. To date, only one nurse has required direct supervision of specimen collection.

Recommendations: Controlling the contamination rate of blood culture samples is germane to effective patient care. When contamination rates creep over the nationally accepted level, educating ED staff in proper blood collection technique can help restore appropriate levels. A post-education follow-up that reinforces proper technique with individuals, as needed, ensures that levels remain low, even when drawing specimens during IV catheter insertion.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDecreasing Blood Culture Contamination Rates in a Pediatric Emergency Roomen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162677-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Decreasing Blood Culture Contamination Rates in a Pediatric Emergency Room</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Sullivan, Kathlyn, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Alfred I. DuPont Hospital for Children</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Registered Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1600 Rockland Rd., Wilmington , DE, 19803, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">302-651-6282</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ksullivan@nemours.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Deena Brecher, RN, MSN, CEN, APRN, BC</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: False positive blood cultures, defined as cultures contaminated with bacteria external to the patient, can result in increased lengths of stay and higher cost of treatment. Because this is a pediatric emergency department (ED), it is important to staff, parents, and patients that we collect blood culture samples during intravenous (IV) catheter insertion when possible, rather than from venipuncture, to minimize distress in the child. However, collecting samples in this way is known to result in higher contamination rates. In April 2004, the monthly contamination rate of blood culture samples (most of them drawn during IV insertion), was 8%, significantly higher than the nationally accepted average of 3% to 5%, as defined by the American Society for Microbiology. A subsequent review of staff practices revealed inconsistent compliance with recommended blood culture collection techniques. An education campaign was therefore implemented, with the goal of bringing contamination rates in line with the national average, even for samples collected during IV catheter insertion.<br/><br/>Implementation: This ongoing project, implemented in August 2004, was conducted in the emergency department of a 180-bed freestanding children's hospital in the Northeast that treats approximately 35,000 patients per year and obtains 30% to 40% of the institution's blood cultures. The education campaign, headed by the clinical nurse specialist, reinforced correct skin preparation and strategies to reduce contamination in the emergency department. The techniques were not new; skin preparation for drawing a blood culture specimen is standardized house-wide, and calls for using a Frepp sponge and Betadine swab. All registered nurses and technicians received retraining in the form of hands-on opportunities and written material, either one-to-one or in small groups. Written policies for obtaining blood samples were reviewed and staff practiced technique on a mannequin. Retraining of the entire staff (including part-time and casual employees) took approximately two months to complete. Staff performance was monitored for a six-month period following reeducation, using medical record documentation. For the first confirmed contaminant, the individual received an email warning; for the second, the staff member reviewed proper technique with the clinical nurse specialist; the third required return demonstration of correct technique with skin preparation and equipment set-up; and the fourth required direct supervision of specimen collection.<br/><br/>Outcomes: From the start of the program in August 2004, through November 2005, ED blood culture contamination rates declined from 8% to under 3%, for all but 3 months, (possibly due to changes in staff and equipment). For the six-month post-training period, four nurses required review of proper technique with the clinical nurse specialist. As of May 2006, the contamination rate dropped to 2.2%, where it remains to date. Because we attained our goal of reducing contamination rates to below 3%, the emergency department continues to routinely draw blood cultures during IV catheter insertion, which has increased staff, patient, and family satisfaction. Although staff and family satisfaction were not formally surveyed, the general consensus among staff is to keep the number of venipunctures to a minimum, a desire parents frequently express. Contamination rates continue to be measured monthly by laboratory staff and tracked closely by the ED nurse manager, clinical nurse specialist, and a staff registered nurse, responsible for compiling data. Individual follow up also continues with results shared in hospital quality improvement committees. To date, only one nurse has required direct supervision of specimen collection.<br/><br/>Recommendations: Controlling the contamination rate of blood culture samples is germane to effective patient care. When contamination rates creep over the nationally accepted level, educating ED staff in proper blood collection technique can help restore appropriate levels. A post-education follow-up that reinforces proper technique with individuals, as needed, ensures that levels remain low, even when drawing specimens during IV catheter insertion.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:16Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:16Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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