Reducing Contaminated Peripheral Blood Cultures in Our Emergency Room- a Quality Improvement Project

Purpose/Objectives: Blood culture contamination is a common problem in the hospital care setting that subsequently affects overall patient care, medical decision making, and health care costs. Patients who have contaminated blood cultures have longer hospitalizations, a longer duration of antibiotic therapy, an increase in invasive procedures and laboratory testing. Every contaminated blood culture has an estimated increased hospital cost of $4,000-$9,000. The standard benchmark for blood culture contamination is 3%. Our aim with the quality improvement (QI) project was to reduce the contamination rate at our children’s hospital from a mean of 4.45% (2014) to 2.5% and maintain it for greater than 5 years (2014-2020).

Design/Methods: We focused our efforts in the primary pediatric emergency room. QI methods we used were a process map, PDSA cycle, and cause-and-effect analysis. We initially sent out surveys to nurses to assess their knowledge, attitudes, perceptions around blood culture contamination and collection. An educational video was produced detailing the protocol for collecting a blood culture in sterile fashion. Nursing staff then participated in a competency skills assessment performed by the ED nursing educator. Approximately 6 months after the skills assessment a post-survey was given to assess knowledge retention. We also implemented a job aid and created a checklist when obtaining blood cultures.

Results: We were initially able to decrease the average contamination rate from 4.45% to below 2.5% in the first year of our project and able to sustain this rate consistently in the first 2 years however when we saw high nursing turnover or ED educator turnover, our contamination rates increased above the benchmark (3%). We continued to add interventions to help sustain our rates to 2.5% or below over the 5-year period.

Conclusion/Discussion: We helped drive our blood culture contamination rates in the ED by using a multi-interventional approach. By focusing on nursing educational modules, implementing competency skills training, creating checklists, and creating a job aid; we were able to reduce blood culture contamination at our children’s hospital. However, our rates of contamination increased when we had rapid turnover of nursing staff. Next steps in our project to sustain best practices will be to create peripheral blood culture carts and blood culture kits with all supplies in one place.

Our project also highlighted that our nurses were not collecting adequate blood volumes independent on weight. Future steps will focus on creating a best practice alert in our electronic medical record for adequate blood culture volumes and an educational supplement.