Department of Emergency Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
Acad Emerg Med. 2013 Jan;20(1):89-97. doi: 10.1111/acem.12057.
Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED.
The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university-affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48-week baseline period (clean technique) and 48-week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first-order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%.
During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period.
A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.
血培养污染是急诊科常见的问题，会导致患者不必要的发病和医疗费用增加。本研究的目的是开发和评估一种质量改进（QI）干预措施，以减少急诊科血培养污染。
作者开发了一种 QI 干预措施来减少急诊科的血培养污染，然后在一项前瞻性的中断时间序列研究中评估其效果。QI 干预措施包括将血培养标本采集技术从传统的清洁程序改为新的无菌程序，标准化使用无菌手套和新的材料包，其中包含 2%洗必泰皮肤消毒剂装置、无菌窗格敷布、无菌针和操作检查表。该干预措施在一家大学附属医院实施，并通过比较 48 周基线期（清洁技术）和 48 周干预期（无菌技术）每两周污染的血培养百分比，使用分段回归分析调整季节性趋势和一阶自相关，评估其对血培养污染的影响。目标是将污染率维持在 3%以下。
在基线期，7389 份培养物中有 321 份（4.3%）被污染，而在干预期，6590 份培养物中有 111 份（1.7%）被污染（p < 0.001）。在分段回归模型中，干预措施与污染绝对减少 2.9%（95%置信区间[CI] = 2.2%至 3.2%）直接相关。在干预期间的每个两周间隔内，污染率都保持在 3%以下。
对急诊科血培养污染的 QI 评估导致了一项有针对性的干预措施的开发，该措施将血培养采集过程从清洁程序转变为完全无菌程序。实施该干预措施可立即和持续降低基线污染率较高的急诊科的污染率。
