Diversion device successfully aids in lowering blood culture contamination rates
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Blood culture contamination was significantly reduced when phlebotomists used an initial specimen diversion device on patients vs. the use of traditional venipuncture, according to a recent study.
“The study was prompted by the fact that many of our patients who had a central line associated blood stream infections (CLABSIs) appeared to have contaminated blood cultures, as defined in the article,” Lucy S. Tompkins, MD, PhD, hospital epidemiologist and the medical director of the infection prevention and control department for Stanford Hospital, told Healio.
“I was also aware that patients with contaminated blood cultures might receive excess antimicrobials, which are associated with further downstream complications, such as Clostridiodes difficile infection, kidney dysfunction, superinfections, longer lengths of stay, etc,” Tompkins said.
Because of this, Tompkins and colleagues trialed an initial specimen diversion device (ISDD) called Steripath on inpatients and ED patients at the hospital — including a large number of patients in the ICUs where blood culture contamination (BCC) seemed to occur more frequently — to assess the impact of the device on inpatient and ED BCC, CLABSI, standardized infection ratios (SIRs) and antibiotic administration.
According to the study, phlebotomists used traditional venipuncture with or without the ISDD, whereas registered nurses (RNs) used traditional venipuncture. BCC events were observed and compared between the two groups between March 17, 2019, and Jan. 21, 2020.
Overall, 24% of blood cultures obtained were from patients in the ICU. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate, whereas phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs, who drew a total of 7,411 blood cultures, had a 0.8% BCC rate.
According to the study, the CLABSI SIR decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019.
Based on these results, the authors wrote that “it is possible to eliminate BCC” and “get to zero” when the ISDD is successfully employed, in line with the recently updated Clinical & Laboratory Standards Institute recommendation, to reduce BCC below a 1% rate.
“Devices such as Steripath that sequester the initial blood containing contaminating bacteria from skin and subdermis into a separate compartment can decrease blood culture contamination rates to very low or even negligible, levels,” Tompkins said.
“Moreover, reduced blood culture contamination can lead to lower CLABSI SIRs. which are a very important measure of quality. Avoidance of blood culture contamination is a very important patient safety and quality effort,”she said.
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