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Obtaining Blood Cultures by Venipuncture versus from Central Lines Impact on Blood Culture Contamination Rates and Potential Effect on Central Line–Associated Bloodstream Infection Reporting

Published online by Cambridge University Press:  28 May 2015

John M. Boyce ,
Jacqueline Nadeau ,
Diane Dumigan ,
Debra Miller ,
Cindy Dubowsky ,
Lenore Reilly  and
Carla V. Hannon
John M. Boyce*
Affiliation:
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut Yale University School of Medicine, New Haven, Connecticut
Jacqueline Nadeau
Affiliation:
Clinical Microbiology Laboratory, Yale-New Haven Hospital, New Haven, Connecticut
Diane Dumigan
Affiliation:
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut
Debra Miller
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
Cindy Dubowsky
Affiliation:
Laboratory Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Lenore Reilly
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
Carla V. Hannon
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
*
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510-3202 (John.Boyce@ynhh.org)
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Abstract

Objective.

Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI).

Design.

An observational study.

Setting.

A 500-bed university-affiliated hospital.

Methods.

A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory.

Results.

The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January–June 2010 to 0.4% during July–December 2012 (P< .001). The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January–June 2010 to 21 (0.5%) of 4,245 during January–June 2012 (P< .001). Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P = 0.25).

Conclusions.

Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1042 - 1047
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
2.Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line–associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31:1286–1289.Google Scholar
3.Shuman, EK, Washer, LL, Arndt, JL, et al.Analysis of central line–associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 2010;31:551–553.Google Scholar
4.Teplick, R. Caveats for comparing catheter-associated bloodstream infection rates. Crit Care Med 2011;39:392–394.Google Scholar
5.Beekmann, SE, Diekema, DJ, Huskins, WC, et al.Diagnosing and reporting of central line–associated bloodstream infections. Infect Control Hosp Epidemiol 2012;33:875–882.Google Scholar
6.Dumigan, DG, Reilly, L, Acompora, M, et al.Beyond the “bundle”: interventions to decrease catheter-associated bloodstream infections in a community teaching hospital. Paper presented at: 22nd European Society of Clinical Microbiology and Infectious Diseases meeting; April 3, 2012; London.Google Scholar
7.Centers for Disease Control and Prevention. National Health-care Safety Network e-news. 2010;5(3):1–5. http://www.cdc.gov/nhsn/PDFs/Newsletters/NHSN_NL_OCT_2010_final.pdf. Accessed January 2013.Google Scholar
8. Johns Hopkins Hospital. Vascular access device (VAD) policy, adult 2012. https://cdn.community360.net/app/jh/csts/clabsi/JHH_VAD_Policy.pdf.Google Scholar
9.Mathew, A, Gaslin, T, Dunning, K, Ying, J. Central catheter blood sampling: the impact of changing the needleless caps prior to collection. J Infus Nurs 2009;32:212–218.Google Scholar
10.Sherertz, RJ, Karchmer, TB, Palavecino, E, Bischoff, W. Blood drawn through valved catheter hub connectors carries a significant risk of contamination. Eur J Clin Microbiol Infect Dis 2011;30:1571–1577.Google Scholar
11.Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788–802.Google Scholar
12.Weinstein, MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol 2003;41:2275–2278.Google Scholar
13.Dwivedi, S, Bhalla, R, Hoover, DR, Weinstein, MP. Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol 2009;47:2950–2951.CrossRefGoogle Scholar
14.Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization. JAMA 1991;265:365–369.Google Scholar
15.Souvenir, D, Anderson, DE JrPalpant, S, et al.Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:1923–1926.Google Scholar
16.Zwang, O, Albert, RK. Analysis of strategies to improve cost effectiveness of blood cultures. J Hosp Med 2006;1:272–276.Google Scholar
17.Gander, RM, Byrd, L, DeCrescenzo, M, Hirany, S, Bowen, M, Baughman, J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 2009;47:1021–1024.Google Scholar
18.Alahmadi, YM, Aldeyab, MA, McElnay, JC, et al.Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011;77:233–236.Google Scholar
19.Snyder, SR, Favoretto, AM, Baetz, RA, et al.Effectiveness of practices to reduce blood culture contamination: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012;45:999–1011.Google Scholar
20.Schifman, RB, Strand, CL, Meier, FA, Howanitz, PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497,134 specimens from adult patients. Arch Pathol Lab Med 1998;122:216–221.Google Scholar
21.Weinbaum, FI, Lavie, S, Danek, M, Sixsmith, D, Heinrich, GF, Mills, SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 1997;35:563–565.Google Scholar
22.Bekeris, LG, Tworek, JA, Walsh, MK, Valenstein, PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005;129:1222–1225.Google Scholar
23.Mermel, LA, Allon, M, Bouza, E, et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.Google Scholar
24.Eskira, S, Gilad, J, Schlaeffer, P, et al.Reduction of blood culture contamination rate by an educational intervention. Clin Microbiol Infect 2006;12:818–821.Google Scholar
25.Suwanpimolkul, G, Pongkumpai, M, Suankratay, C. A randomized trial of 2% chlorhexidine tincture compared with 10% aqueous povidone-iodine for venipuncture site disinfection: effects on blood culture contamination rates. J Infect 2008;56:354–359.Google Scholar