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Obtaining Blood Cultures by Venipuncture versus from Central Lines Impact on Blood Culture Contamination Rates and Potential Effect on Central Line–Associated Bloodstream Infection Reporting

Published online by Cambridge University Press:  28 May 2015

John M. Boyce ,
Jacqueline Nadeau ,
Diane Dumigan ,
Debra Miller ,
Cindy Dubowsky ,
Lenore Reilly  and
Carla V. Hannon
John M. Boyce*
Affiliation:
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut Yale University School of Medicine, New Haven, Connecticut
Jacqueline Nadeau
Affiliation:
Clinical Microbiology Laboratory, Yale-New Haven Hospital, New Haven, Connecticut
Diane Dumigan
Affiliation:
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, New Haven, Connecticut
Debra Miller
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
Cindy Dubowsky
Affiliation:
Laboratory Support Services, Yale-New Haven Hospital, New Haven, Connecticut
Lenore Reilly
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
Carla V. Hannon
Affiliation:
Department of Nursing, Yale-New Haven Hospital, New Haven, Connecticut
*
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510-3202 (John.Boyce@ynhh.org)
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Abstract

Objective.

Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI).

Design.

An observational study.

Setting.

A 500-bed university-affiliated hospital.

Methods.

A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory.

Results.

The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January–June 2010 to 0.4% during July–December 2012 (P< .001). The proportion of blood cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January–June 2010 to 21 (0.5%) of 4,245 during January–June 2012 (P< .001). Based on estimated excess hospital costs of $3,000 per contaminated blood culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P = 0.25).

Conclusions.

Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1042 - 1047
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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