Quality Improvement in Pediatric Blood Cultures
Abstract
Background:
In the era of modern blood culturing, virtually all blood culture contamination occurs during the collection phase. At Children's Hospital of The King's Daughters (CHKD), 70% of the contaminated blood cultures come from the emergency department (ED). Nationwide, 60% of patients received unnecessary treatment as a result of contaminated blood cultures. This results in increased pharmacy charges from $210-$12,611 and laboratory charges ranging between $2,397-$11,152 per patient. In addition, unnecessary medical treatment due to contaminated blood cultures leads to patients' discomfort, decreased hospital reputation, and increased selective antibiotic pressure leading to resistant organisms. In this study, observation of blood cultures being drawn in the ED will be done, with the goal of identifying where in the drawing process contamination could be occurring.
Methods:
We learned the standard job instructions provided by CHKD for blood culture collection via peripheral venipuncture. This included proper hand hygiene, maintaining an aseptic field, and proper collection of the blood. After learning the procedure and acceptable variations, we went to the ED and observed blood cultures as the ED techs completed them. As they were performing them, we noted any deviations or incorrect protocols performed during the collection process and compiled the data after our observations.
Results:
Of the 5 observed blood cultures, 4 were performed incorrectly. In all 4 incorrect collections, at least 2 of the steps were performed incorrectly. In 3 of them, sterile gloves were not worn which immediately compromises the sterile field and its contents. Another consistent point of failure was the lack of alcohol prep before cleaning the site with CHG or betadine.
Conclusion:
These findings suggest that the ED may be seeing an increase in contamination of pediatric blood cultures due to poor maintenance of the sterile field during the collection process and poor adherence to the job instruction sheet. Reinforcement of the job instruction sheet and aseptic techniques should improve the collection and help reduce contamination during collection.