Using Innovative Technology to Reduce Blood Culture Contamination Rate

Aim: : In 2018, this Emergency Department’s (ED) Blood Culture Contamination (BCC) rate was 4.92% with 176 identified contaminated blood cultures costing the hospital an estimated $823,504.00. The purpose of this quality improvement project was to decrease BCC rates and thereby decrease unnecessary hospital and patient cost.

Framework:: The IHI model for improvement was used for this project.

Setting:: This study was performed at an urban Level 1 trauma center in the South.

Stakeholder Team:: The Assistant Manager and the bedside RN identified the issue and developed an action plan. The educator coordinated the development of education to staff. The bedside RN and educator performed hands-on education with staff. The Quality Medical director assisted with compliance and tracking. The Quality Assistant Manager provided 1:1 staff feedback on performance.

Methods: : Contaminated blood cultures fail to offer clear direction to providers in determining a patient’s plan of care and lead to unnecessary antibiotics, antibiotic resistance, increased lengths of stay, and increased costs. Values indicate that a false-positive blood culture can cost $4,679 expenditure to both hospital and patient (Economic health care costs of blood culture contamination: A systematic review, 2019)). A thorough review of evidence-based best practices and available innovative technology was conducted. Based on that review, the ED team implemented the use of specimen diversion device technology to reduce the rate of blood culture contamination. In addition to one-on-one education of the diversion device, dedicated leader rounding and online module education on proper blood culture collection technique was also conducted. Following implementation, individual contamination rates were tracked. One-on-one accountability and follow-up were conducted with those who continued to have contamination results. This follow-up consisted of practice feedback, diversion device use and proper collection technique.

Outcomes:: Through robust staff education and specimen diversion device implementation BCC rates for the ED decreased from 4.92% to 2.85%. Reflecting a hospital cost reduction of $322, 851. The ED has maintained success within departmental goals over the course of 1 year. Increase in contamination rates were noted during peak waves of COVID. It is unclear if the addition of isolation precautions had a factor in this increase. An increase in contamination rates was noted during a period when individual contamination rate tracking was delayed due. Once resumed, a decrease in contamination rates has occurred. Indicating a positive correlation to practice feedback and better performance.

Implications:: The use of innovative technology in combination with 1:1 staff feedback has proven to be an effective intervention in improving blood culture contamination rates.