A national survey of interventions and practices in the prevention of blood culture contamination and associated adverse health care events

Published:January 18, 2018DOI:
      The scientific literature indicates that blood culture contamination often leads to inappropriate antimicrobial treatment, adverse patient occurrences, and potential reporting of false-positive central line–associated bloodstream infections. The findings of a national infection prevention survey of blood culture practices and related interventions in hospitals support the need for infection preventionists to expand their participation in the review of topics related to the ordering and collection of blood for culture.

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        • Garcia R.A.
        • Spitzer E.D.
        • Beaudry J.
        • Beck C.
        • DiBlasi R.
        • Gilleeny-Blabac M.
        • et al.
        Multidisciplinary 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.
        Am J Infect Control. 2015; 43: 1222-1237
        • Alahmandi Y.M.
        • Aldeyab M.A.
        • McElnay J.C.
        • Scott M.G.
        • Darwish Elhajji F.W.
        • Magee F.A.
        • et al.
        Clinical and economic impact of contaminated blood cultures within the hospital setting.
        J Hosp Infect. 2011; 77: 233-236
        • Segal G.S.
        • Chamberlain J.M.
        Resource utilization and contaminated blood cultures in children at risk for occult bacteremia.
        Arch Pediatr Adolesc Med. 2000; 154: 469-473
        • Gilligan P.H.
        Blood culture contamination: a clinical and financial burden.
        Infect Control Hosp Epidemiol. 2013; 34: 22-23
        • Pien B.C.
        • Sundaram P.
        • Raoof N.
        • Costa S.F.
        • Mirrett S.
        • Woods C.W.
        • et al.
        The clinical and prognostic importance of positive blood cultures in adults.
        Am J Med. 2010; 123: 819-828
        • Morgan D.J.
        • Croft L.D.
        • Deloney V.
        • Popovich K.J.
        • Crnich C.
        • Srinivasan A.
        • et al.
        Choosing wisely in healthcare epidemiology and antimicrobial stewardship.
        Infect Control Hosp Epidemiol. 2016; 37: 755-760
        • Cohen S.H.
        • Gerding D.N.
        • Johnson S.
        • Kelly C.P.
        • Loo V.G.
        • McDonald L.C.
        • et al.
        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. 2010; 31: 432-455
        • Van der Heijden Y.F.
        • Miller G.
        • Wright P.W.
        • Shepard B.E.
        • Daniels T.L.
        • Talbot T.
        Clinical impact of blood cultures contaminated with coagulase-negative staphylococci at an academic medical center.
        Infect Control Hosp Epidemiol. 2011; 32: 623-625
        • Backman L.A.
        • Melchreit R.
        • Rodriguez R.
        Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department.
        Am J Infect Control. 2010; 38: 832-838
        • Lin M.Y.
        • Hota B.
        • Klan Y.M.
        • Woeltje K.F.
        • Borlawsky T.B.
        • Doherty J.A.
        • et al.
        Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates.
        JAMA. 2010; 304: 2035-2041
        • Beekmann S.E.
        • Diekema D.J.
        • Huskins C.
        Diagnosing and reporting of central line-associated bloodstream infections.
        Infect Control Hosp Epidemiol. 2012; 33: 875-882
        • Schifman R.B.
        • Strand C.L.
        • Meier F.A.
        • Howanitz P.J.
        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. 1998; 122: 216-221
        • Clinical and Laboratory Standards Institute (CLSI)
        Principles and procedures for blood cultures: approved guideline, Vol. 46, No. 31.
        Clinical and Laboratory Standards Institute, Wayne (PA)2007 (CLSI document M47-A)
        • Patton R.G.
        Blood culture contamination definitions can obscure the extent of blood culture contamination: a new standard for satisfactory performance is needed.
        Infect Control Hosp Epidemiol. 2016; 37: 736-738
        • Bowen C.M.
        • Coleman T.
        • Cunningham D.
        Reducing blood culture contaminations in the emergency department: it takes a team.
        J Emerg Nurs. 2016; 42: 306-311
        • Hall K.K.
        • Lyman J.A.
        Updated review of blood culture contamination.
        Clin Microbiol Rev. 2006; 19: 788-802
        • Morgan D.J.
        • Malani P.
        • Diekema D.J.
        Diagnostic stewardship—leveraging the laboratory to improve antimicrobial use.
        JAMA. 2017; 318: 607-608
        • Willems E.
        • Smismans A.
        • Cartuyvels R.
        • Coppens G.
        • van Vaerenbergh K.
        • van den Abeele A.M.
        • et al.
        The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals.
        Diag Microbiol Infect Dis. 2012; 73: 1-8
        • Woods-Hill C.Z.
        • Fackler J.
        • McMillian K.N.
        • Martinez D.A.
        • Toerper M.F.
        • Voskertchian A.
        • et al.
        Association of a clinical practice guideline with blood culture use in critically ill children.
        JAMA Pediatr. 2017; 171: 157-164
        • Wiggers J.B.
        • Xiong W.
        • Daneman N.
        Sending repeat cultures: is there a role in the management of bacteremic episodes? (SCRIBE study).
        BMC Infect Dis. 2016; 16: 286-295
        • Dawson S.
        Blood culture contaminants.
        J Hosp Infect. 2014; 87: 1-10
        • Snyder S.R.
        • Favoretto A.M.
        • Baetz R.A.
        • Derzon J.H.
        • Madison B.M.
        • Mass D.
        • et al.
        Effectiveness of practices to reduce blood culture contamination: a laboratory medicine best practices systematic review and meta-analysis.
        Clin Biochem. 2012; 45: 999-1011
        • Foggiato G.F.
        • Tuon F.F.
        • Becker G.
        • dos Santos A.H.
        Reduction of blood culture contamination rates after implementation of a phlebotomy team.
        Am J Infect Control. 2017; 45: 698-702
        • Bekeris L.G.
        • Tworek J.A.
        • Walsh M.K.
        • Valenstein P.N.
        Trends in blood culture contamination: a College of American Pathologists Q-Tracks Study of 356 institutions.
        Arch Pathol Lab Med. 2005; 129: 1222-1225
        • Mermel L.A.
        • Allon M.
        • Bouza E.
        • Craven D.E.
        • Flynn P.
        • O'Grady N.P.
        Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America.
        Clin Infect Dis. 2009; 49: 1-45
        • Septimus E.
        Clinician guide for collecting cultures.
        (Centers for Disease Control and Prevention; Available from:)
        • Boyce J.M.
        • Nadeau J.
        • Dumigan D.
        • Miller D.
        • Reilly L.
        • Hannon C.V.
        Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and potential effect on central line-associated bloodstream infection reporting.
        Infect Control Hosp Epidemiol. 2013; 34: 1042-1047
        • Self W.H.
        • Speroff T.
        • Grijalva C.G.
        • McNaughton C.D.
        • Ashburn A.
        • Liu D.
        • et al.
        Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study.
        Acad Emerg Med. 2013; 20: 89-97
        • Jarvis W.R.
        • Murphy C.
        • Hall K.R.
        • Fogle P.J.
        • Karchmer T.B.
        • Harrington G.
        • et al.
        Health-care associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.
        Clin Infect Dis. 2009; 49: 1821-1827
        • Infusion Nurses Society
        Infusion nursing standards of practice.
        J Inf Nurs. 2011; 34: S1-110
        • Dwivedi S.
        • Bhalla R.
        • Hoover D.R.
        • Weinstein M.P.
        Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures.
        J Clin Microbiol. 2009; 47: 2950-2951
        • Patton R.G.
        • Schmitt T.
        Innovation for reducing blood culture contamination: initial specimen diversion technique.
        J Clin Microbiol. 2010; 48: 4501-4503
        • Rupp M.E.
        • Cavalieri R.J.
        • Maroff C.
        • Lyden E.
        Reduction of blood culture contamination through use of initial specimen diversion device.
        Clin Infect Dis. 2017; 65: 201-205

      Linked Article

      • Reducing blood culture contamination in an intensive care unit through weekly reports and feedback
        American Journal of Infection ControlVol. 47Issue 4
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          We read with great interest the article by Garcia et al1 regarding a national survey of interventions and practices to prevent blood culture contamination (BCC) and associated adverse healthcare events. Strategies to control contamination rates were initiated and included: identifying specific indicators for cultures, reviewing collection methods and handling of specimens, nursing education and training programs, as well as a review of hospital policy. Rates of contamination for individual nurses obtaining the specimens were calculated and shared with them.
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