Lead IV Practitioner Guys and St Thomas@ NHS Foundation Tust London, England, United Kingdom
Purpose - What was the goal of the study?: Economically false positive blood culture results place an unnecessary financial burden on a hospital and have a significant negative impact on the patient. Would the introduction of an initial specimen diversionary device (ISSD) that automatically diverts the initial flash of blood reduce false positives in Accident and Emergency.
Background - What was the problem? Why was it important?: Blood cultures are the gold standard for determining the presence of a bacteraemia. The cost of contaminated blood cultures impact the overall costs of hospitalisation through delays in discharge, the administration on unnecessary antibiotics at a time when antimicrobial stewardship is high on the health care agenda, additional laboratory testing and delays in discharge of up to 2 days. In addition to these, the patient is also subjected to the needless insertion of an intravenous access device with all the associated risk of complications or the unplanned removal of a central venous access device on which they are reliant. Standards have been set that recommend that hospitals achieve a contamination rate of < 3%. Despite multiple quality improvement projects over many years the blood culture contamination rates in this central London Accident and Emergency department have consistently averaged > 6%. A solution was needed to reduce these unacceptable contamination rates.
Results - What were the findings?: The project ran over a 5 month period from May to September 2021. Data was collected on approximately 500 patients using the initial specimen diversionary device. Two methods of collecting blood cultures were used. These were either by inserting a cannula and then taking the specimen or using a butterfly vacutainer system and a separate peripheral stab. Historically, the method of inserting a cannula and taking a blood culture has been the preferred method in this Accident and Emergency department despite the potential increased risk of contamination, and thus false positives, and being against our hospital policy. The results of the project showed a reduction in false positive contamination rate to < 2% which has been shown to be statistically relevant. This is an overall reduction of 66%. In addition, there was no difference in contamination rates whichever method chosen which provided assurance when taking a blood culture from a newly inserted cannula.
Conclusions - What do the final outcomes mean?: The results of the quality improvement project made clear that use of the diversionary device mitigated the risk of contaminated blood cultures. These results were shared with the Accident and Emergency team who were eager to continue using the product. The results were taken to the hospital Infection Control committee who endorsed use of the device across the hospital system. An implementation phase has seen its adoption in Accident and Emergency and also in the Intensive Care Units across the hospital. The next stage is implementation in specialist areas including Parenteral Nutrition, Haematology and Oncology, and the Renal departments.
