An Interprofessional Approach to Decreasing Blood Culture Contamination in the Emergency Department

Aim: : In response to an increase in blood culture contamination rates in the emergency department, our team developed an interprofessional approach to addressing this lagging indicator. This project aims to identify opportunities for improvement in the blood culture collection process in the Emergency Department utilizing an interprofessional approach.

Framework:: The Plan-Do-Study-Act cycle was utilized to carry out this project.

Setting:: A teaching, level I Adult and Pediatric Trauma Center who also serves the county in the South-Central region of the United States.

Stakeholder Team:: This project was approved and received support from the unit's Executive Nursing Director. The Assistant Director, Quality Improvement and the Emergency Nursing Services Coordinator served as the project leads. Emergency Center Technicians were nominated by the Nurse Managers to be Blood Culture Champions. These individuals were required to complete 1:1 training with a phlebotomist prior to fulfilling the role.

Methods: : Prior to the implementation of this project, blood cultures were collected in the department primarily by nurses. Although all staff completed hospital-wide training on the collection process, observations revealed varied processes being utilized during specimen collection. Interventions included: education reinforcement, selection of blood culture champions by ED Leadership, individual 1:1 real time training of champions by phlebotomists, blood culture collection by trained champions only, and utilization of badge identifiers to distinguish champions. Phase 1 of the project focused on the area of the Adult ED averaging 48% of the unit’s contaminations between April to June 2022. Of the 181 contaminations, 157 (87%) were collected by registered nurses. Phase 2 focused on the area with the second highest contamination rate (24%) followed by Phase 3 which expanded to the entire Adult ED. Data collection was reviewed monthly utilizing a report generated by the Microbiology Services department.

Outcomes:: Overall blood culture contamination decreased from 5.96% to 2.65% in 22 weeks. Reinforcement of education during weeks one and two yielded a decrease of 2.86%. Contamination rates maintained after the implementation of the blood culture champions beginning in week 3, resulting in a sustainment of weekly contamination rates averaging 3.15%.

Implications:: Blood cultures are recognized as one of the most important tests performed in microbiology laboratories as they aid in the diagnosis of bloodstream infections. Contamination results in prolonged length of stay, increased healthcare costs, unnecessary or inappropriate antibiotic utilization, and a reduction in quality of care. The results of phases 1 and 2 have revealed a sustained decrease in contamination rates and an improvement in quality of care. Further data collection and process evaluation is needed to identify future interventions.