Blood Culture Contamination: You Can’t Touch That!
Issue: Blood culture contamination has been an ongoing quality improvement project at Bethesda North Emergency Department (ED). The target rate is 3%. The goal is to be consistently below 3%. The ED rates were inconsistent and often times above the target rate.
Project Description: The ED quality team was charged with re-evaluating processes to improve the quality outcome. The ED had collaborated with the microbiology lab in years past to gather data regarding blood culture contamination. The quality team determined that re-education was needed to ensure proper collection methodology for the nurses and the emergency department technicians. Following the education, an aggressive follow up campaign was started to ensure quality review to improve blood culture contamination.
Results: In the two year period from January 2011 through December 2012 the ED blood culture contamination rate was over 3% more than half the time (13 months out of 24). The highest contamination rate was over 5%. The ED collects a large volume of blood cultures ranging month to month from 200 to 500 blood culture sets.
After a review of blood culture collection expectations with ED staff members, the ED clinical nurse specialist received patient specific contamination concerns. Each chart is then reviewed with individual staff members to determine rationale for contamination. Since the education campaign, the ED blood culture contamination rate has been below 3% for the past six months.
Lessons Learned: Providing ongoing feedback to staff members is positive way to reinforce the importance of quality outcomes. Education to newly hired employees is important and must not be overlooked. Providing explanations regarding the importance of quality improvement measures has helped to meet quality goals. Improving efficiencies is an important component that should be addressed. The ED clinical nurse specialist is currently working to develop a blood culture collection kit to ensure standardized practice for blood culture collection in the ED.
Submitters: Jeannie Burnie, MS, APRN, ACNS-BC, CEN; Jeannie_burnie@trihealth. Com; 513-865-7496