Premium
Reducing Blood Culture Contamination in the Emergency Department: An Interrupted Time Series Quality Improvement Study
Author(s) -
Self Wesley H.,
Speroff Theodore,
Grijalva Carlos G.,
McNaughton Candace D.,
Ashburn Jacki,
Liu Dandan,
Arbogast Patrick G.,
Russ Stephan,
Storrow Alan B.,
Talbot Thomas R.
Publication year - 2013
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12057
Subject(s) - medicine , emergency department , contamination , checklist , blood culture , emergency medicine , confidence interval , surgery , antibiotics , nursing , psychology , ecology , microbiology and biotechnology , cognitive psychology , biology
Objectives Blood culture contamination is a common problem in the emergency department ( ED ) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement ( QI ) intervention for reducing blood culture contamination in an ED . Methods The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university‐affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48‐week baseline period (clean technique) and 48‐week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first‐order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%. Results During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [ CI ] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period. Conclusions A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.