Blood cultures contaminated: “Bundle to achieve acceptable proportions”
Abstract
Introduction. The problem of blood cultures contamination is very frequent in hospital care, it leads to the administration of unnecessary antibiotics and prolongs hospitalization. Main goal. To apply a bundle to reduce the proportion of blood culture contamination. Secondary objectives. Carry out an anonymous survey to detect improvement opportunities in the blood culture extraction technique. Methodology. Study design: Quasi-experimental study that evaluated the proportion of blood culture contamination before and after implementing an own Bundle. The baseline proportion of blood culture contamination was determined (Jan-July 2022), the intervention was performed (August 2022) and the post-intervention contamination proportion was established (Sep-April 2023). Intervention: The structure, procedure, and staff knowledge were analyzed through an own survey to detect improvement areas. Laboratory technicians were trained on the sampling procedure through a simulation using an artificial arm. A six measurements bundle´s was designed, the blood culture taking procedure was adapted, and the staff was trained. Statistical analysis. The proportion of contaminated blood cultures between the pre and post periods was analyzed using Chi2 and the relationship between the proportion of the pre and post period vs the literature (3.00% acceptable contamination) using the Z test for a proportion. A p<0.05 was considered statistically significant. Stata 8 software was used. Results. During the study, a total of 3,965 blood cultures were analyzed. Of these, 1,978 correspond to the pre-intervention period and 1,987 correspond to the post-intervention period. During the pre-intervention, 61 blood cultures contaminated were detected (3.08% vs 3.00% in the literature, p:0.5866) while in the post-intervention stage there were 30 blood cultures contaminated (1.51% vs 3.00% in the literature, p:0.0000). The proportion of blood cultures contaminated was halved, 3.08% vs 1.51%, p: 0.001. An anonymous survey was carried out before and after the intervention, achieving improvements in the technique of taking blood cultures. Conclusion. The implementation of the own Bundle for the extraction of blood cultures, allowed to reduce the proportion of contamination by half. The analysis of the survey allowed us to identify opportunities for improvement in the blood culture sample collection technique.
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References
2. Wilson ML, Mltchell M, Morris A. 2007. Principles and procedures for blood cultures; approved guldellne. CLSI document M47-A. Clinical and Laboratory Standards Institute, Wayne, PA
3. Alahmadi YM, Aldeyab MA, McElnay JC, Scott MG, Darwish Elhajji FW, Magee FA, Dowds M, Edwards C, Fullerton L, Tate A, Kearney MP. 2011. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 77:233–236. doi: 10.1016/j.jhin.2010.09.033. [PubMed] [CrossRef] [Google Scholar]
4. Richter SS, Beekman SE, Croco JL, Diekema DJ, Koontz FP, Pfaller MA, Doern GV. 2002. Minimización del análisis de contaminantes de hemocultivos: implementación y evaluación de un algoritmo de laboratorio. J Clin Microbiol 40 :2437–2444. doi: 10.1128/jcm.40.7.2437-2444.2002. [Artículo gratuito de PMC] [PubMed] [CrossRef] [Google Scholar] [Lista de referencias]
5. Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. 2009. Impacto de los hemocultivos extraídos por flebotomía en las tasas de contaminación y los costos de atención médica en el departamento de emergencias de un hospital. J Clin Microbiol 47 :1021–1024. doi: 10.1128/JCM.02162-08. [Artículo gratuito de PMC] [ PubMed] [CrossRef ] [ Google Scholar] [ Lista de referencias ]
6. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. 1997. La importancia clínica de los hemocultivos positivos en la década de 1990: una evaluación prospectiva integral de la microbiología, la epidemiología y el resultado de la bacteriemia y la fungemia en adultos. Clin Infect Dis 24 :584–602. doi: 10.1093/clind/24.4.584. [ PubMed ] [CrossRef] [Google Académico]
7. Diputado Weinstein. 2003. Contaminación de cultivos de sangre: problemas persistentes y progreso parcial. J Clin Microbiol 41 :2275–2278. doi: 10.1128/jcm.41.6.2275-2278.2003. [ Artículo gratuito de PMC ] [ PubMed ] [ CrossRef ] [ Google Scholar ] [ Lista de referencias ]
8. Christenson RH, Snyder SR, Shaw CS, Derzon JH, Black RS, Mass D, Epner P, Favoretto AM, Liebow EB. 2011. Mejores prácticas de medicina de laboratorio: revisión sistemática de evidencia y métodos de evaluación para la mejora de la calidad. Clin Chem 57 :816–825. doi: 10.1373/clinchem.2010.157131. [PubMed] [CrossRef] [ Google Scholar ] [ Lista de referencias ]
9. Bates DW, Goldman, L, Lee, TH. Hemocultivos contaminantes y utilización de recursos. Las verdaderas consecuencias de los resultados falsos positivos. Revista de la Asociación Médica Estadounidense 1991; 265: 365 – 369. CrossRef Google Académico PubMed
10. Souvenir D, Anderson DE, Palpant S, Mroch H, Askin S, Anderson J, Claridge J, Eiland J, Malone C, Garrison MW, Watson P, Campbell DM. 1998. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 36:1923–1926. [PMC free article] [PubMed] [Google Scholar]
11. Surdulescu S, Utamsingh D, Shekar R. 1998. Phlebotomy teams reduce blood-culture contamination rate and save money. Clin Perf Qual Health Care 6:60–62. [PubMed] [Google Scholar]
12. Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. 2009. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 47:1021–1024. doi: 10.1128/JCM.02162-08. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
13. Hauck K, Zhao X. 2011. How dangerous is a day in the hospital? A model of adverse events and length of stay for medical inpatients. Med Care 49:1068–1075. doi: 10.1097/MLR.0b013e31822efb09. [PubMed] [CrossRef] [Google Scholar]
14. Baron EJ, Weinstein MP, Dunne WM Jr, Yagupsky P, Welch DF, Wilson DM. 2005. Cumitech 1C, hemocultivos IV. ASM Press, Washington, DC. [ Google académico]
15. Centros para el Control y la Prevención de Enfermedades. Contaminación de hemocultivos: una descripción general de los programas de control de infecciones y administración de antibióticos que trabajan con el laboratorio clínico. Disponible en: https://www.cdc.gov/antibiotic-use/core-elements/pdfs/fs-bloodculture-508.pdf . Consultado el 21 de agosto de 2022.
16. Snyder SR, Favoretto AM, Baetz RA, Derzon JH, Madison BM, Mass D, Shaw CS, Layfield CD, Christenson RH, Liebow EB. 2012. Eficacia de las prácticas para reducir la contaminación de hemocultivos: revisión sistemática y metanálisis de las mejores prácticas de medicina de laboratorio. Clin Biochem 45 :999–1011. doi:
17. Organización Mundial de la Salud. Una atención limpia es una atención más segura. OMS, 2020.
18. Hinojosa M., Guzzi L., Camblor F., & Christin M. (2022). ¿Cambió la adherencia al lavado de manos en tiempos de SARS-CoV-2?. Actualizaciones En Sida E Infectología, 30(108). https://doi.org/10.52226/revista.v30i108.
19. OMS. Sus cinco momentos para la higiene de las manos. Octubre, 2010. http://www.who.int/ gpsc/information_centre/gpsc_5_momentos_poster_es.pdf
20. Centros para el Control y la Prevención de Enfermedades (2019) Higiene de manos en entornos sanitarios. https://www.cdc.gov/handhygiene/index.html
21. Mimoz O, Karim A, Mercat A, Cosseron M, Falissard B, Parker F, Richard C, Samii K, Nordmann P. 1999. Chlorhexidine compared with povidoneiodine as skin preparation before blood culture. A randomized, controlled trial. Ann Intern Med 131:834–837. https://doi.org/10.7326/0003-4819-131-11-199912070-00006.
22. Maiwald M, Chan ES. 2012. The forgotten role of alcohol: a systematic review and meta analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis. PLoS One 7:e44277. https://doi.org/10.1371/journal.pone.0044277.
23. Asociación de Enfermeras de Urgencias. 2016. Guía de práctica clínica: prevención de la contaminación de hemocultivos. https://www.ena.org/docs/default-source/resource-library/practice-resources/cpg/bcccpg2c37f1815b664d2fa8d7e9fd0f475a41.pdf?sfvrsn=6d1899fb_12 .
24. Departamento de Salud. 2007. Salvar vidas: tomar hemocultivos: un resumen de las mejores prácticas. https://webarchive.nationalarchives.gov.uk/20120118171812/http://hcai.dh.gov.uk/files/2011/03/Document_Blood_culture_FINAL_100826.pdf .
25. Rey TC, Precio PB. 1963. Una evaluación de los yodóforos como antisépticos para la piel. Surg Gynecol Obstet 116 :361–365. [PubMed ] [Google Académico]
26. Self WH, Mickanin J, Grijalva CG, Grant FH, Henderson MC, Corley G, Blaschke DG II, McNaughton CD, Barrett TW, Talbot TR, Paul BR. 2014. Reducción de la contaminación de hemocultivos en los departamentos de emergencia de hospitales comunitarios: una evaluación multicéntrica de una intervención de mejora de la calidad. Acad Emerg Med 21 :274–282. doi: 10.1111/acem.12337. [Artículo gratuito de PMC] [PubMed] [CrossRef] [Google Scholar]
27. Thomas S, Cheesbrough J, Plumb S, Bolton L, Wilkinson P, Walmsley J, Diggle P. 2011. Impacto de un kit de recolección de hemocultivos en la calidad del muestreo de hemocultivos: el miedo y la ley de las consecuencias no deseadas. J Hosp Infect 78 :256–259. doi: 10.1016/j.jhin.2011.04.012. [ PubMed ] [ CrossRef ] [ Google Académico ]
28. Mermel LA, Maki DG. 1993. Detección de bacteriemia en adultos: consecuencias del cultivo de un volumen inadecuado de sangre. Ann Intern Med 119 :270–272. doi: 10.7326/0003-4819-119-4-199308150-00003. [ PubMed ] [ CrossRef ] [ Google Académico ]
29. Association for Professionals in Infection Control and Epidemiology (APIC). APIC Position paper: Safe injection, infusión and medication vial practides in health care. 2016. Disponible en http://www.apic.org/Resource_/TinyMceFileManager/Position_Statements/2016APICSIPPositionPaper.pdf
30. Morrison K, Holt,K. The effectiveness of clinically indicated replacement of peripheral intravenous catheters: An evidence review with implications for clinical practice. Worldviews Evid Based Nurs. 2015 Aug; 12(4):187-98. doi: 10.1111/wvn.12102. Epub 2015 Aug 4. Disponible en http://onlinelibrary.wiley.com/doi/10.1111/wvn.12102/pdf
31. Hopkins K, Huynh S, McNary C, Walker A, Nixon R, Craighead JE. 2013. Reducción de las tasas de contaminación de hemocultivos: un enfoque sistemático para mejorar la calidad de la atención. Am J Infect Control 41 :1272–1274. doi: 10.1016/j.ajic.2013.02.019. [PubMed] [CrossRef] [Google Académico]
32. Zimmerman FS, Assous MV, Yinnon AM, Wiener-Well Y. 2018. Reducción de la contaminación de hemocultivos mediante una boleta de calificaciones departamental. J Hosp Infect 99 :236–237. doi: 10.1016/j.jhin.2018.02.023. [PubMed] [CrossRef] [Google Académico]
33. Gibb AP, Hill B, Chorel B, Brant R. 1997. Reducción en la tasa de contaminación de hemocultivos por retroalimentación a los flebotomistas. Arch Pathol Lab Med 121 :503–507. [PubMed] [Google Académico
