Reduction of Contaminated Blood Cultures

Connie Clark Vice President of Nursing Services

Pat Sather Hartell Microbiology Supervisor

Jennifer LeClercq Emergency Department Manager

Cathy Paulus Infection Control Coordinator

Jean Wojtanek Lab Manager

Emergency Department Nursing Staff

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Aim Statement

Exposure to antibiotics can lead to acquisition of multidrug resistant organisms Additional diagnostic testing Prolonged hospital stay or unnecessary admission Increased costs and utilization of resources Decreases the positive predictive value of the blood culture system *Clinical Laboratories Standards Institute/College of American Pathologists*Clinical Laboratories Standards Institute/College of American Pathologists

Goal: To reduce blood culture contaminants to 3% or below

*Potential Consequences of Contaminated Blood Cultures:

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Multidisciplinary Team Plan

Form a multidisciplinary team to reduce blood culture contaminants

Review historical data related to blood culture results

Review literature for “best practices” in obtaining blood cultures

Create a blood culture competency to address staff knowledge deficit related to blood culture collection

Direct efforts to decrease contamination rate for ED specimens

Target staff collecting blood cultures: Phlebotomists and Emergency Department staff

Explore clinical lab blood culture systems

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Actions Implemented

Required ED nursing staff to complete Blood Culture competency at hire and quarterly Required return demonstration of specimen collection including itemized steps on competency Educated staff on basic knowledge regarding skin antisepsis, central line catheter biofilm, and consequences of contaminated blood culture results Developed department trainers to educate staff Implemented Versatrek blood culture collection system Performed analysis of potential costs attributed to contaminated specimens

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Ongoing Actions

Monitor blood culture contaminant results monthly

Communicate contaminant results to department manager

Share department results with staff monthly

Provide direct feedback of individual performance

Re-educate staff as needed

Share results with key stakeholders

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Blood Culture Contamination Rate

6.87

9.29

5.43

6.50

4.9

3.5

2.2

1.0

2.62.3

1.70 1.9

2.62.48

3.36

4.35

3.92.7

1.01.4

2.02.3 2.1

0.5

3.062.73

4.50 4.634.77

3.43.3

2.93.00 2.6

1.8

3.00

0

3

6

9

12

ED Phlebotomy Overall Rate

Before (Annual competency) After ( Quarterly competency)

Versatrek Blood Culture System Implementation in ED

Goal ≤ 3%

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Perc

ent

Blood Culture Contamination Rate: Emergency DepartmentGottlieb Memorial Hospital

For Quality Improvement Purposes Only

1

2

3

4

5

6

7

8

9

Mean

UCL

Mean

LCL

Analysis: Since individual counseling and education of ED staff in Q1 2007, the rate of blood culture contamination has decreased consistently. Further improvement noted after implementation of new blood culture system house-wide. The ED achieved rates below the benchmark goal of 3% in the last two quarters. Overall mean average is at 4.62.

Individual Counseling and competency of ED personnel

Versatrek Blood Culture System Implemented house-wide

Goal 3%

Perc

ent

Blood Culture Contamination Rate: PhlebotomyGottlieb Memorial Hospital

For Quality Improvement Purposes Only

Temporary: UCL=3.50, Mean=1.76, LCL=0.02 (mR=2)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Mean

UCL

Mean

LCL

Versatrek Blood Culture System Implemented house-wide

Goal 3%

Analysis: The Phlebotomy department consistently performs below the benchmarking goal of 3%. Further improvement noted after implementation of new blood culture system house-wide. Overall mean average is maintained at 1.76.

Cost of a Contaminated Blood Culture

Estimated Cost per Contaminant= $4500.00**

Estimate Cost Avoidance Associated with the Reduction Contaminated Blood Culture Rate

5 fewer contaminants per quarter would yield potential cost savings of $90,000 annually

** Reference: College of American Pathologists, 2000** Reference: College of American Pathologists, 2000

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Analysis

Emergency Department achieved 2.7% contamination rate 3rd quarter calendar year 2008

Achieved 2.6% overall contamination rate 4th quarter calendar year 2008 Preliminary 1St quarter calendar year 2009 data: overall contamination rate 2.8% Sustained improvement achieved in 2008 with implementation of Versatrek blood culture collection system and quarterly blood culture competency training

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Next Steps

Intervene with education and analysis of any upward trending

Continue ED staff requirement to complete quarterly competency

Ongoing review of literature for best practices related to skin antisepsis, specimen collection, and care and maintenance of a central line Maintain collaborative team and continue reporting to key stakeholders Sustain blood culture contamination rate at or below 2% (revised national benchmark)

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