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Blood Culture Contamination: A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

Published online by Cambridge University Press:  02 January 2015

Laraine L. Washer*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Carol Chenoweth
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Hae-Won Kim
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
Mary A. M. Rogers
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
Anurag N. Malani
Affiliation:
Saint Joseph Mercy Hospital, Ann Arbor, Michigan
James Riddell IV
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Latoya Kuhn
Affiliation:
Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Bernard Noeyack Jr
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Harry Neusius
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Duane W. Newton
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
*
Division of Infectious Diseases, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 (laraine@med.umich.edu).

Abstract

Objective.

To determine relative rates of blood culture contamination for 3 skin antisepsis interventions—10% povidone iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% chlorhexidine gluconate in 70% isopropyl alcohol (CHG)—when used by dedicated phlebotomy teams to obtain peripheral blood cultures.

Design.

Randomized crossover trial with hospital floor as the unit of randomization.

Setting.

Teaching hospital with 885 beds.

Patients.

All adult patients undergoing peripheral blood culture collection on 3 medical-surgical floors from May 2009 through September 2009.

Intervention.

Each antisepsis intervention was used for 5 months on each study floor, with random crossover after a 1-month washout period. Phlebotomy teams collected all peripheral blood cultures. Each positive blood culture was adjudicated by physicians blinded to the intervention and scored as a true positive or contaminated blood culture. The primary outcome was the rate of blood culture contamination for each antisepsis agent.

Results.

In total, 12,904 peripheral blood culture sets were evaluated, of which 735 (5.7%) were positive. There were 98 contaminated cultures, representing 13.3% of all positive cultures. The overall blood culture contamination rate for the study population was 0.76%. Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics (P = .18), yielding 0.58% with PI (95% confidence interval [CI], 0.38%-0.86%), 0.76% with IT (95% CI, 0.52%-1.07%), and 0.93% with CHG (95% CI, 0.67%-1.27%).

Conclusion.

Choice of antiseptic agent does not impact contamination rates when blood cultures are obtained by a phlebotomy team and should, therefore, be based on costs or preference.

Trial Registration.

ClinicalTrials.gov identifier: NCT01216761.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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