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Education-based ICU intervention reduces blood culture contamination
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An education-based intervention appeared to yield improvements in the rate of blood culture contamination among critically ill ICU patients, according to recent data.
In a prospective, observational study with concurrent controls, researchers evaluated 656 consecutive blood cultures (BCs) drawn during a 6-month period at an ICU in a university tertiary referral hospital. The intervention consisted of a 2-hour course on BC collection techniques that was presented to half of the critical care nurses. The protocol for this technique — based on recommendations by the Spanish Society of Microbiology and Infectious Diseases — included the use of sterile gloves, skin cleansing with chlorhexidine, BC bottle top cleansing with antiseptic, and injection of at least 5 mL blood in each culture without needle exchange.
The other half of the critical care nurses served as a control group using standard techniques. Saprophytic skin bacteria was isolated from the BCs, and two independent observers analyzed the clinical significance of this bacteria.
Of the 656 BCs collected, 47% were extracted through the optimized technique, and 53% were extracted through standard protocols. There were 157 BCs that tested positive for saprophytic microorganisms, and 89% of these organisms were unrelated to infection.
BCs taken by the optimal technique group had a lower prevalence of coagulase-negative staphylococci isolation compared with those taken by the standard technique group (14% vs. 26%; P < .001), along with a lower rate of contamination due to Acinetobacter baumannii (0.3% vs. 2%; P = .013) or coagulase-negative staphylococci (12% vs. 21%; P = .002). BCs taken using the optimal technique had a contamination rate of 13% vs. 23% in the standard group (P < .005). In the optimal technique BCs, the rate of contamination was higher in BCs drawn through a catheter than those taken via venipuncture (17% vs. 7%; P = .028).
“Our study addresses the concept of BC contamination rate specifically in critically ill patients and shows for the first time the effectiveness of an education-based intervention to improve this quality of care indicator,” the researchers wrote. “Given that despite using proper aseptic protocol, contamination rates of BCs obtained through venous catheters was clearly superior to that of BCs drawn by venipuncture, it seems necessary to design an intervention or tool to use catheters safely.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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