ADS 02 - How Does Blood Culture Collection Around the Time of Death Impact Mandated Reporting of Hospital Associated Infections?

Wednesday, June 28, 2023

3:30 PM – 3:50 PM

Location: W103 A/B; Orange County Convention Center

CE: .33

CNE Credits: 0.33
CME Credits: 0.33

Presenter(s)

Amelia H. Cardiff, BS, CIC (she/her/hers)

Sr. Infection Preventionist II
UPMC Mercy Hospital Infection Prevention and Control
Pittsburgh, Pennsylvania

Disclosure(s): No financial relationships to disclose

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Co-Author(s)

Mohamed H. Yassin, MD, CIC

Associate Professor of Medicine DIrector Infection Control
University of Pittsburgh
Pittsburgh, Pennsylvania
Heather Dixon, MSN, RN CIC, CPHQ

Director, Quality & Infection Prevention
UPMC Mercy
Pittsburgh, Pennsylvania

Moderator(s)

Luz Caicedo, MPH, CPH, CIC, CRCST, VA-BC

Infection Prevention Manager
AdventHealth Celebration, Florida

Disclosure(s): No financial relationships to disclose

Co-Moderator(s)

Krista Doline, BS, MLS (ASCP), CIC, FAPIC

Infection Preventionist
Piedmont Healthcare
Fayetteville, Georgia

Disclosure(s): No financial relationships to disclose

Background: Blood cultures (BC) are the primary method of diagnosing bloodstream infections (BSI). BCs may also result positive due to contamination and translocation of microbes across tissue barriers. Tissue barrier breaks occur during chemotherapy, ischemic bowel, and around patient death (PD). Reporting BCs collected just prior to and resulting after PD can potentially increase incidence of BSIs including central line associated BSIs (CLABSI) that do not represent infection. Laboratory stewardship points to cancelation of incubating BCs after PD.

Methods: We performed a retrospective review of all BCs collected immediately prior to PD at an urban, 435 bed acute care hospital from January 1, 2019, to September 30, 2022. All positive BCs, with identified organisms resulting after PD, were reviewed for hospital associated infections (HAI) using National Health and Safety Network (NHSN) definitions. Postmortem BC results were compared with reported HAIs during the same period to determine total BSIs reported after PD. In October 2022, a protocol was implemented to review PD BCs in real time to intervene and discontinue BCs pending results.

Results: There were 48,845 BC results with 4,868 (10%) positive. 407 (8%) BCs were finalized after PD. Of these, 127 potentially met HAI definitions. When compared to NHSN reported events during the study period, 44 PD BCs matched HAI events including 8 CLABSI, 11 primary and 25 secondary BSIs. Post protocol implementation, 43 BCs have been discontinued to date without complications.

Conclusions: Agonal spread and translocation of bacteria around PD are non-infectious outcomes that affect surveillance investigations. Implementing a stewardship protocol to discontinue BCs after PD can reduce irrelevant HAIs. BCs resulting after PD are not clinically relevant and add to healthcare costs. BCs from autopsies are not used by NHSN and those resulting after PD may require similar criteria.

Learning Objectives:

Describe the importance of blood cultures in diagnosing bloodstream infections and examine alternate factors attributing to positive blood culture results.
Identify facility specific blood culture data with respect to blood cultures resulting positive after patient death.
Evaluate the implementation of a stewardship protocol to discontinue blood cultures after patient death for reduction of irrelevant hospital associated infections.