Best Practice Recommendations Really Do Work Best: Reducing Blood Culture Contaminates

2.50
Hdl Handle:
http://hdl.handle.net/10755/162732
Type:
Presentation
Title:
Best Practice Recommendations Really Do Work Best: Reducing Blood Culture Contaminates
Abstract:
Best Practice Recommendations Really Do Work Best: Reducing Blood Culture Contaminates
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Vose, Courtney, RN, MSN, CRNP, CEN
P.I. Institution Name:Lehigh Valley Hospital and Health Network
Title:Director, Emergency Services
Contact Address:I-78 and Cedar Crest Blvd., Allentown, PA, 18105, USA
Contact Telephone:(610) 402-8112
Co-Authors:Anne Sanders A.D., T.P.; Bonnie Dahlgren T. P.; and Terry L. Burger RN, BSN, CIC
Purpose: Blood culture contamination contributes to longer hospital stays and costs and exposes patients to unnecessary antibiotics to treat infections that aren't really there. The national laboratory standard contamination rate for blood culture specimens is 3%. Our emergency department's (ED) contamination rate for 2005 was 5.16%. To determine why our rate was significantly higher, unit management formed a multidisciplinary team to study the problem. Our goal was to identify the source of contamination and determine what changes needed to be made to bring our rate more in line with the national average.

Design: This quality improvement project involved three steps: (1) a retrospective review of all matched pairs of blood cultures to confirm whether blood culture isolates represented true bacteremia or contamination; (2) a literature review of blood culture collection techniques; (3) modification of our blood culture collection procedures, according to the findings; and (4) comparisons of contamination rates, cost, patient length of stay and patient satisfaction scores before and after implementation of new procedures.

Setting: Located in an 800-bed teaching hospital with Magnet designation, this high volume, high acuity ED is a Level 1 trauma center in Pennsylvania.

Subjects: All blood cultures drawn in the emergency department during the project as described above.

Methods: Matched pairs of blood cultures drawn in 2005, were analyzed. Using standard clinical and microbiological criteria, the contamination rate was determined to be much higher than the national laboratory standard. A literature review was consequently conducted to identify evidence-based best practice recommendations for blood culture collection procedures. The literature revealed that blood cultures are more likely to be contaminated when drawn from an intravenous catheter by individuals other than a phlebotomy teamùexactly what we had been doing up to then. We therefore changed our practice and began drawing blood cultures by direct venipuncture and by technical partners re-educated and validated as competent to perform the procedures, in compliance with the recommendations in the literature. We continued to analyze pairs of blood cultures and also compared levels of patient satisfaction level, associated costs for the procedure, and length of stay before and after the intervention.

Results: Since implementing the new practice in February 2006, our average rate of blood culture contamination has dropped to 2.46% from a rate of 5.16%, in 2005, with a range of 1.6% to 3.3%. Rather than increase costs, the process actually resulted in cost containment, with no drop in patient satisfaction scores per Press Ganey surveys or increased length of stay measured at interval from arrival to disposition.

Recommendations: Most emergency department leaders do not support the practice of having a single designated group draw blood cultures by separate venipuncture. They argue the practice is inefficient and thus more costly, and likely to result in lower patient satisfaction and increased lengths of stay. Our project demonstrates just the opposite. Since adapting the new procedure, we have significantly lowered our contamination rate and actually contained cost, without adverse effects on patient satisfaction and length of stay.
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.titleBest Practice Recommendations Really Do Work Best: Reducing Blood Culture Contaminatesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162732-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Best Practice Recommendations Really Do Work Best: Reducing Blood Culture Contaminates</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">Vose, Courtney, RN, MSN, CRNP, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Lehigh Valley Hospital and Health Network</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director, Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">I-78 and Cedar Crest Blvd., Allentown, PA, 18105, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(610) 402-8112</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">courtney.vose@lvh.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Anne Sanders A.D., T.P.; Bonnie Dahlgren T. P.; and Terry L. Burger RN, BSN, CIC</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Blood culture contamination contributes to longer hospital stays and costs and exposes patients to unnecessary antibiotics to treat infections that aren't really there. The national laboratory standard contamination rate for blood culture specimens is 3%. Our emergency department's (ED) contamination rate for 2005 was 5.16%. To determine why our rate was significantly higher, unit management formed a multidisciplinary team to study the problem. Our goal was to identify the source of contamination and determine what changes needed to be made to bring our rate more in line with the national average. <br/><br/>Design: This quality improvement project involved three steps: (1) a retrospective review of all matched pairs of blood cultures to confirm whether blood culture isolates represented true bacteremia or contamination; (2) a literature review of blood culture collection techniques; (3) modification of our blood culture collection procedures, according to the findings; and (4) comparisons of contamination rates, cost, patient length of stay and patient satisfaction scores before and after implementation of new procedures.<br/><br/>Setting: Located in an 800-bed teaching hospital with Magnet designation, this high volume, high acuity ED is a Level 1 trauma center in Pennsylvania.<br/><br/>Subjects: All blood cultures drawn in the emergency department during the project as described above.<br/><br/>Methods: Matched pairs of blood cultures drawn in 2005, were analyzed. Using standard clinical and microbiological criteria, the contamination rate was determined to be much higher than the national laboratory standard. A literature review was consequently conducted to identify evidence-based best practice recommendations for blood culture collection procedures. The literature revealed that blood cultures are more likely to be contaminated when drawn from an intravenous catheter by individuals other than a phlebotomy team&ugrave;exactly what we had been doing up to then. We therefore changed our practice and began drawing blood cultures by direct venipuncture and by technical partners re-educated and validated as competent to perform the procedures, in compliance with the recommendations in the literature. We continued to analyze pairs of blood cultures and also compared levels of patient satisfaction level, associated costs for the procedure, and length of stay before and after the intervention.<br/><br/>Results: Since implementing the new practice in February 2006, our average rate of blood culture contamination has dropped to 2.46% from a rate of 5.16%, in 2005, with a range of 1.6% to 3.3%. Rather than increase costs, the process actually resulted in cost containment, with no drop in patient satisfaction scores per Press Ganey surveys or increased length of stay measured at interval from arrival to disposition.<br/><br/>Recommendations: Most emergency department leaders do not support the practice of having a single designated group draw blood cultures by separate venipuncture. They argue the practice is inefficient and thus more costly, and likely to result in lower patient satisfaction and increased lengths of stay. Our project demonstrates just the opposite. Since adapting the new procedure, we have significantly lowered our contamination rate and actually contained cost, without adverse effects on patient satisfaction and length of stay.</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:13Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:13Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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