Especially for busy hospital emergency departments, avoiding blood culture contamination is a constant challenge for those tasked with collecting blood culture specimens
Better, faster diagnosis and treatment of sepsis continues to be a major goal at hospitals, health networks, and other medical facilities throughout the United States. Yet microbiologists and clinical laboratory managers continue to be frustrated with how frequently contaminated blood culture specimens show up in the laboratory.
A recent poll of more than 200 healthcare professionals who attended a sponsored webinar hosted by Dark Daily, showed that nearly 10% of those who responded reported an overall blood culture contamination rate in their hospitals at above 4%.
However, the arrival of new technology may provide hospital staff with a way to reduce contamination rates in blood culture specimens, in ways that improve patient outcomes.
The effectiveness of a new tool, the Steripath Initial Specimen Diversion Device (ISDD), is being demonstrated in a growing number of prominent hospitals in different regions of the United States. What will be particularly intriguing to clinical laboratory professionals is that the ISDD is capable of collecting blood while minimizing the problems caused by human factors, micro-organisms, and skin plugs or fragments. This device was developed by Magnolia Medical Technologies of Seattle, Wash.
The ISDD isolates the initial 1.5 to 2.0 mL aliquot of the blood culture sample, which is most likely to be contaminated with microscopic skin fragments colonized with bacteria. The device diverts this initial aliquot into a sequestration chamber, mechanically isolating it from the rest of the sample, and then automatically opens an independent sterile pathway into blood culture collection bottles.
Such technology may be welcomed by medical laboratory professionals based in hospitals and other healthcare facilities. That’s because it is the lab staff that typically identifies a contaminated blood culture specimen and must go back to the nurses, staffers, and physicians on the wards to have them redraw an acceptable specimen that will produce an accurate, reliable result. Patients under these circumstances generally continue on unnecessary broad-spectrum antibiotics, and their length of stays have been reported to increase by two days on average.
Problem of Decentralized Phlebotomy
One problem contributing to high blood culture rates is that, in many hospitals and health networks, phlebotomy has been decentralized and is no longer managed by the clinical laboratory.
“I’ve seen the havoc decentralized phlebotomy wreaks on contamination rates of blood culture rates,” stated Dennis Ernst, Director of the Center for Phlebotomy Education based in Mio, Mich. “That staffing model, which swept through the hospital industry in the late 1990s, may have looked good on paper, but I can count the number of facilities that have successfully decentralized on the fingers of one hand. And I don’t know of any decentralized setting that has an acceptable blood culture contamination rate.”
Ernst, a medical technologist and educator, has seen the difficulty in lowering contamination rates in a decentralized, multidisciplinary workforce. He has worked for more than 20 years advocating for best practices in the diagnostic blood collection industry and has helped clinical laboratory facilities achieve a 90% reduction in their contamination rates. Ernst considers blood culture contamination to be among the “low-hanging fruit” in every laboratory that can be easily and permanently corrected with the proper approach.
“One statistic we’ve heard over and over again is that the American Society of Microbiology established the ‘threshold’ for blood culture contamination to be 3%,” Ernst said. “I believe strongly that a 1% contamination rate or less is what should be required and that it’s not only achievable, but sustainable.”
Regardless of staffing mix, blood culture contamination is a common problem in the emergency department, Ernst explained during his presentation, “Evidence-Based Technology to Reduce Blood Culture Contamination, Improve Patient Care, and Reduce Costs in Your Clinical Lab or Hospital,” which is available free for streaming.
Improving Patient Care and Reducing Avoidable Costs
With unnecessary antibiotic use, increased length of stay, and the cost of unnecessary laboratory testing at issue, hospitals are tracking blood culture collection results and exploring ways to reduce episodes of blood culture contamination. On these and other healthcare quality improvement aims, providers are publishing study results on contamination reduction and potential direct and indirect hospital cost savings. For example:
- At the University of Nebraska, a prospective, controlled, matched-pair clinical study showed an 88% reduction in blood culture contamination with a 12-month sustained rate of 0.2% when Steripath was used by phlebotomists in the ED. The author estimated the institution would save approximately $1.8 million if the technology was adopted hospitalwide, reported an article in Clinical Infectious Diseases in July 2017.
- Florida-based Lee Health system’s microbiology laboratory reported an 83% reduction in contamination rates comparing their standard method to ISDD for a seven-month trial period. Their systemwide potential cost avoidance estimates ranged from $4.35 million to nearly $11 million, reported an article in the Journal of Emergency Nursing in November 2018.
- Researchers from Massachusetts General reported that ISDD is the single most effective intervention so far explored for reducing costs related to false-positive blood cultures, potentially saving the typical 250- to 400-bed hospital $1.9 million or $186 per blood culture and preventing 34 hospital-acquired conditions (including three C. difficile cases). The recent article “Model to Evaluate the Impact of Hospital-based Interventions Targeting False-Positive Blood Cultures on Economic and Clinical Outcomes” in the Journal of Hospital Infection explains more.
Blood Facilities Should be Tracking Their Contamination Rate
One of the biggest challenges faced during blood sample collection is making sure an organism is not inadvertently introduced into the blood. Therefore, importance has been placed on clinical laboratories and other healthcare providers developing policies and procedures to limit the introduction of likely contaminants.
“I believe most places monitor blood culture contamination, but they are not doing much that is effective to reduce it,” Ernst said. “That’s a real problem.”
To assist healthcare providers in blood culture quality improvement, the free webinar, “Evidence-Based Technology to Reduce Blood Culture Contamination, Improve Patient Care, and Reduce Costs in Your Clinical Lab or Hospital,” available on-demand through Dark Daily, can be downloaded by clicking here, or by pasting the URL “https://darkintelligenceprogramsondemand.uscreen.io/programs/evidence-based-technology-to-reduce-blood-culture-contamination-improve-patient-care-and-reduce-costs-in-your-clinical-lab-or-hospital” into a web browser.
This program, which polled more than 200 healthcare professionals, explores the clinical and economic significance of blood culture contamination, the downstream impact of false-positive blood cultures, and case-study evidence of sustained reductions in contamination.