Major articleMultidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line–associated bloodstream infections
Section snippets
Background
This article reports the findings of a project aimed at identifying evidence-based best practices in the preanalytical collection and handling phase5 and program management component of BC processing as spearheaded by members of the Blood Culture Task Force of Stony Brook University Hospital. The task force was initially formed as a subgroup of the hospital-wide effort to reduce CLABSI, later expanded to include quality improvement in the identification of true pathogens and decreasing
Enhancing the recovery of true pathogens (ie, avoidance of false-negative BCs)
The identification of true pathogens and subsequent antibiotic sensitivities provide the clinician with vital information for providing optimal treatment. The need to properly obtain blood for microbiologic culture takes on even greater significance when institutions consider that sepsis is currently the most costly hospital condition ($20.29 billion) among inpatients,6 has accounted for a 32% increase in hospitalizations in recent years,7 and is the leading cause of admission to a hospital for
Review of the literature
The evidence presented in this article was generated using a literature search for articles and other publications that addressed best practices in BC collection and handling; occurrence of false-negatives and the effect on the recovery of true pathogens, false-positives, and the effect on CLABSIs; and quality improvement programs. The search was conducted using Medline, PubMed, and Ovid for articles published in English (January 1990-March 2015) using the keywords blood culture, blood culture
Clinical indications for BCs
BCs should be obtained for specific clinical indications.47 An in-depth review of the literature by Willems et al indicates that BCs should be obtained in any patient with fever (≥38°C), hypothermia (≤38°C), leukocytosis, an absolute granulocytopenia, or a combination of these markers. Specific conditions in which BCs need to be drawn include sepsis, meningitis, suspected catheter-related bacteremia, infectious endocarditis, arthritis, osteomyelitis, and fever of unknown origin. BCs may be
ED interventions
It has been estimated that up to 50% of all BCs drawn in hospitals originate in an ED. Periods of increasing crowding in EDs have been associated with significant increases of BCC, suggesting that lapses in proper collection techniques by health care workers were contributory.135 Table 3 summarizes studies that have reported successful strategies in reducing contamination rates and other associated outcomes in EDs.53, 71, 78, 79, 136, 137, 138, 139, 140, 141, 142 A common practice in Pediatric
Conclusion
The currently available body of research indicates that improper collection of BCs is associated with suboptimal treatment of patients, increased financial burdens, and potential over-reporting of CLABSI. Best practices in the collection and handling of BC specimens require a thorough understanding of a variety of issues, including appropriate indications for drawing BCs, criteria for drawing from venipuncture sites versus intravascular catheters, selection and appropriate application of
Acknowledgments
We thank Lynn Hadaway, MEd, RN-BC, CRNI, Terry Murphy, BS, RN, CRN, CRNI, VA-BC, Wm. Dan Roberts, ACNP, PhD, and Francina Singh, RN, BScN, MPh, CIC, for their review and insights.
References (153)
- et al.
The clinical and prognostic importance of positive blood cultures in adults
Am J Med
(2010) - et al.
Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department
Am J Infect Control
(2010) Blood culture contaminants
J Hosp Infect
(2014)- et al.
Guidelines on blood cultures
J Microbiol Immunol Infect
(2010) - et al.
Blood cultures: key elements for best practices and future directions
J Infect Chemother
(2010) - et al.
Update on blood cultures: how to obtain, process, report, and interpret
Clin Microbiol Infect
(2013) - et al.
The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals
Diagn Microbiol Infect Dis
(2012) - et al.
Effectiveness of practices to reduce blood culture contamination: a laboratory medicine best practices systematic review and meta-analysis
Clin Biochem
(2012) - et al.
Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients
Chest
(2003) - et al.
Comparison of contamination rates of catheter-drawn and peripheral cultures
J Hosp Infect
(2005)
Use of the nonwire central line hub to reduce blood culture contamination
Chest
Reduction in the contamination rate of blood cultures collected by medical staff in the accident and emergency department
Clin Eff Nurs
Reducing blood culture contamination
J Hosp Infect
Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences
J Hosp Infect
Blood culture contamination: having your cake and eating it
J Hosp Infect
Reducing false-positive blood cultures in a pediatric emergency department
J Emerg Nurs
The origin of coagulase-negative staphylococci isolated from blood cultures
J Hosp Infect
A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination
Am J Med
A randomized trial of 2% chlorhexidine tincture compared with 10% aqueous povidone-iodine for venipuncture site disinfection: effects on blood culture contamination rates
J Infect
Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock
Intensive Care Med
Device associated module BSI. Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection)
Preanalytic laboratory errors: identification and prevention
Mayo Clin Communique
Blood culture contamination. Q-Tracks 2013 monitor instructions
Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497,134 specimens from adult patients
Arch Pathol Lab Med
Trends in blood culture contamination: a College of American Pathologists Q-Tracks Study of 356 institutions
Arch Pathol Lab Med
Principles and procedures for blood cultures: approved guideline. CLSI document M47-A
Updated review of blood culture contamination
Clin Microbiol Rev
Contaminant blood cultures and resource utilization: the true consequences of false-positive results
JAMA
Clinical and economic impact of contaminated blood cultures within the hospital setting
J Hosp Infect
Impact of blood cultures drawn by phlebotomy on contamination on contamination rates and health care costs in a hospital emergency department
J Clin Microbiol
Analysis of strategies to improve cost effectiveness of blood cultures
J Hosp Med
Resource utilization and contaminated blood cultures in children at risk for occult bacteremia
Arch Pediatr Adolesc Med
Impact of a false positive blood culture result on the management of febrile children
Pediatr Infect Dis J
Blood culture contamination: a clinical and financial burden
Infect Control Hosp Epidemiol
Blood cultures positive for coagulase negative staphylococci: antisepsis, pseudobacteremia and therapy of patients
J Clin Microbiol
Clinical significance of potential contaminants in blood cultures among patients in a medical center
J Microbiol Immunol Infect
Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious disease society of America (IDSA)
Infect Control Hosp Epidemiol
The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults
Clin Infect Dis
Blood culture contamination with Enterococci and skin organisms: implications for surveillance definitions of primary blood stream infections
Am J Infect Control
Distribution of pathogens in central line-associated bloodstream infections among patients with or without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition
Infect Control Hosp Epidemiol
Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010
Infect Control Hosp Epidemiol
Clinical impact of blood cultures contaminated with coagulase-negative staphylococci at an academic medical center
Infect Control Hosp Epidemiol
Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis
Crit Care Med
Cited by (0)
Conflicts of interest: None to report.