Emergency Department Blood Culture Contamination. Quality Improvement Project FY 2012 Staff Presentation. The Clinical Problem. Evidence of a high rate of blood culture contamination in the emergency department. ED Blood Culture Contamination Rate. Aim/Goal.
Quality Improvement Project
Evidence of a high rate of blood culture contamination in the emergency department
To reduce emergency department blood culture contamination rate before December 1, 2011.
By January 1, 2012 to have an emergency department blood culture contamination rate 3% or less.
Pull together a multi-disciplinary team of stake holders to re-examine practice.
Needle penetrates skin and/or needle penetrates blood culture bottle, that has not been prepared per recommended guidelines for obtaining blood cultures.
Normal Skin Flora:
Coagulase negative Staph
Diphtheroids (aka Corynebacterium)
The process of investigation:
1) Share the data
2) Impart concern
3) Review the blood culture collection procedure
4) Add “IV start kits” to IV carts
5) Remove IV supplies from bedside carts
6) Direct feedback to care provider who drew a
contaminated blood culture
Quality Improvement = Culture of Safety!!!
Feedback, feedback and more feedback!!!!!
Feedback to all persons with contamination
Less than 3 % contamination rate
Conversation with staff to understand WHY contamination occurred
Fix all that can be fixed
CHG (2.3) vs. PI (7.3) vs. alcohol (9.1)
A blood culture is really two bottles (a set)
2 sets must be drawn (i.e. 4 Bottles)
1 set from a unique site (i.e. two sticks)
Aerobic first (r/t air in the tubing)
Steps to clean skin followed precisely
Difference between CHG & Alcohol
Don’t touch skin where you stick, please
HH & PPE, Florence Nightingale was right
1) Validate physician order for IV therapy.
2) Provide patient education as indicated.
3) Gather supplies and wash hands, maintain standard precautions.
4) Don gloves.
5) Wash intended venipuncture site with anti-infective soap and water if needed.
6) Remove hair from chosen site with clippers or scissors if needed.
7) Disinfect the insertion with a single-dose antiseptic solution, 2% chlorhexidine is the antiseptic of choice, and allow to become visibly dry (40 seconds).
8) Connect the injection cap to extension tube (if using).
9) Prime injection cap and tube with saline flush, leave the saline flush attached to cap.
10) Apply tourniquet above selected site.
11) Access the vein with the catheter at a 10-15 degree angle.
12) Once blood is seen advance the catheter proper off the styled.
13) Depress the needle retraction button on the catheter, while holding pressure over the IV site to reduce the amount of blood that will exit the catheter.
14) Attach the injection cap and extension tubing (if used).
15) Place the transparent occlusive dressing over the hub of the IV catheter and insertion site.
16) Secure hub with a single piece of tape over the hub or wing.
17) Flush the IV catheter with the saline, observe for complications.
18) Place a second piece of tape over the extension tubing.
19) Label the site with initial, size and date placed.
20) May apply a piece of net gauze to provide additional security.
The lab offers this (policy)
1) Identify the patient
2) Locate the vein to be used
3) Tear open the chlorascrub packet and remove the swab, do not unfold.
4) Apply the swab to the desired puncture site by holding swab between thumb and index finger. Apply swab to the skin using repeated back and forth stroke for 15 seconds.
The lab offers this (policy) continued
5) Allow the skin to air dry for 30 seconds. Do not blot or wipe dry. DO NOT Touch the skin after it is disinfected. Do not re-use swab.
6) While the site is drying, disinfect the visible part of the rubber stopper of the bottles using 70% alcohol wipes. Leave on the stopper until ready to use the bottles.
7) Mark the bottle with the recommended draw amount.
The lab offers this (policy) continued
1) Is effective for about 4 hours after it is applied (Alcohol ONLY when wet)
2) If anything drops onto the prepared skin, CHG kills it (Not with Alcohol)
3) CHG Kills bugs in two different ways (Alcohol only one way)
4) Results show that infection rates are 50 - 400% greater with Alcohol.
Blood Culture Contamination Rates