The Effectiveness of Chloraprep TM in the Reduction of Blood Culture Contamination Rates in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/163014
Type:
Presentation
Title:
The Effectiveness of Chloraprep TM in the Reduction of Blood Culture Contamination Rates in the Emergency Department
Abstract:
The Effectiveness of Chloraprep TM in the Reduction of Blood Culture Contamination Rates in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Tepus, Dwayne, RN, BSN
P.I. Institution Name:Summa Health System Hospitals
Title:Staff Nurse
Contact Address:41 Arch Street, Akron, OH, 44304 -1499, USA
Contact Telephone:(330) 375-3051
Co-Authors:Sandra R. Cox, RN, BSN; Susan Hazelett, RN, MS
Purpose: Contamination of blood cultures by coagulase-negative Staphylococci on the skin has been associated with increased length of stay, in addition to increased hospital, laboratory, and pharmacy charges. Poor skin preparation is usually the cause of contamination. A newer product made of 2% chlorhexidine and 70% isopropanol (Chloraprep TM) requires a 15 second drying time, compared to two minutes for the widely-used povidine-iodine solutions, making it an attractive candidate for improved clinical effectiveness. The purpose of this study was to compare blood culture contamination rates in samples obtained in the emergency department (ED) for one year using a tincture of iodine skin preparation technique to the contamination rate for one year using the Chloraprep TM skin preparation technique. Previous studies have shown that both techniques are efficacious, however studies of the effectiveness of one technique compared to the other in an ED setting are lacking. Design: This was an observational study. Setting: The setting was a 963-bed community teaching hospital?s emergency department in the Northeastern United States. Sample: All blood cultures drawn in the emergency department one year prior to and one year following the implementation of the Chloraprep TM skin preparation technique. Method: This study used a pre-/post-implementation design. All blood cultures obtained via a peripheral vein or femoral vein were included in the comparison. Data regarding blood culture contamination rates are routinely tracked by our institution?s clinical laboratory. All staff (RNs and LPNs) who previously obtained blood cultures using the tincture of iodine preparation were inserviced individually on use of the Chloraprep TM skin preparation product by the principal investigator. Chi-square analysis was used to compare the pre- and post-implementation proportion of contaminated blood cultures. Results: In the year prior to implementation of the Chloraprep TM technique, 251 of 7158 blood cultures (3.5%) were contaminated, compared to 169 of 7606 (2.2%) in the year after implementation. This difference was statistically significant (p<.0001). Contamination rates did not differ substantially between individual nurses using either technique. Skin preparation costs using ChloraprepTM increased $.48 per sample ($.20 for the tincture of iodine and $.68 for ChloraprepTM , excluding nursing time). Recommendations: Although there are numerous skin preparation techniques for blood culture collection with proven efficacy, in busy clinical settings proper site preparation may be difficult. Although this was not a randomized trial, our results show a statistically significant improvement in contamination rates using the ChloraprepTM technique. Two studies in the 1990s showed that the extra costs associated with contaminated blood cultures were in excess of $4,000 per patient. Thus, the increased costs associated with the Chloraprep TM technique (7,606 x $.48= $3,650) are easily absorbed by the savings associated with the lower contamination rate (approximately 100 fewer contaminated samples x $4,000 = $400,000). Based on these findings, we recommend the use of the Chloraprep TM technique in the ED setting.
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.titleThe Effectiveness of Chloraprep TM in the Reduction of Blood Culture Contamination Rates in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/163014-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Effectiveness of Chloraprep TM in the Reduction of Blood Culture Contamination Rates in the Emergency Department</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Tepus, Dwayne, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Summa Health System Hospitals</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">41 Arch Street, Akron, OH, 44304 -1499, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(330) 375-3051</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">HazeletS@summa-health.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Sandra R. Cox, RN, BSN; Susan Hazelett, RN, MS<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: Contamination of blood cultures by coagulase-negative Staphylococci on the skin has been associated with increased length of stay, in addition to increased hospital, laboratory, and pharmacy charges. Poor skin preparation is usually the cause of contamination. A newer product made of 2% chlorhexidine and 70% isopropanol (Chloraprep TM) requires a 15 second drying time, compared to two minutes for the widely-used povidine-iodine solutions, making it an attractive candidate for improved clinical effectiveness. The purpose of this study was to compare blood culture contamination rates in samples obtained in the emergency department (ED) for one year using a tincture of iodine skin preparation technique to the contamination rate for one year using the Chloraprep TM skin preparation technique. Previous studies have shown that both techniques are efficacious, however studies of the effectiveness of one technique compared to the other in an ED setting are lacking. Design: This was an observational study. Setting: The setting was a 963-bed community teaching hospital?s emergency department in the Northeastern United States. Sample: All blood cultures drawn in the emergency department one year prior to and one year following the implementation of the Chloraprep TM skin preparation technique. Method: This study used a pre-/post-implementation design. All blood cultures obtained via a peripheral vein or femoral vein were included in the comparison. Data regarding blood culture contamination rates are routinely tracked by our institution?s clinical laboratory. All staff (RNs and LPNs) who previously obtained blood cultures using the tincture of iodine preparation were inserviced individually on use of the Chloraprep TM skin preparation product by the principal investigator. Chi-square analysis was used to compare the pre- and post-implementation proportion of contaminated blood cultures. Results: In the year prior to implementation of the Chloraprep TM technique, 251 of 7158 blood cultures (3.5%) were contaminated, compared to 169 of 7606 (2.2%) in the year after implementation. This difference was statistically significant (p&lt;.0001). Contamination rates did not differ substantially between individual nurses using either technique. Skin preparation costs using ChloraprepTM increased $.48 per sample ($.20 for the tincture of iodine and $.68 for ChloraprepTM , excluding nursing time). Recommendations: Although there are numerous skin preparation techniques for blood culture collection with proven efficacy, in busy clinical settings proper site preparation may be difficult. Although this was not a randomized trial, our results show a statistically significant improvement in contamination rates using the ChloraprepTM technique. Two studies in the 1990s showed that the extra costs associated with contaminated blood cultures were in excess of $4,000 per patient. Thus, the increased costs associated with the Chloraprep TM technique (7,606 x $.48= $3,650) are easily absorbed by the savings associated with the lower contamination rate (approximately 100 fewer contaminated samples x $4,000 = $400,000). Based on these findings, we recommend the use of the Chloraprep TM technique in the ED setting.</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:03Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:03Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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