Successful Reduction of Blood Culture Contamination in an Emergency Department by Monitoring and Feedback

Blood Culture (BC) contamination is a common problem in the Emergency Department (ED) and is associated with prolonged length of patient stay and excess costs.

The study aimed to investigate the impact of monthly monitoring and feedback of BC results on contamination rates.

Data from a previous study showed that the contamination rate in the ED consistently exceeded the recommended level. This triggered an ad hoc Quality Improvement team to develop and implement a corrective action plan. In 2017, BC contamination rates were reported to the ED on a monthly basis. In response to this, ED staff conducted intensified educational workshops, followed by private counselling and competency assessment of nurses who collected contaminated BCs.

A total of 12 educational workshops were conducted in February and March, 2017. The intervention resulted in >60% reduction in the contamination rate, from 8.6% baseline level to less than 3%. Of the 2660 BC sets drawn in 2017 from 1318 patients, 128 (4.8%) were contaminated, accounting for 39.5% of the total number of positive cultures. Sixty percent of the contaminated BCs grew Coagulase-negative Staphylococcus species; other contaminants included Corynebacterium spp., Micrococcus spp., Propionibacterium spp., viridans Streptococcus, and Neisseria spp.

Continuous monitoring and feedback of contamination rates reduced BC contamination.