Huang Qiao-Hui, Lin Yi-Chen, Huang Wei-Siang
BSN, RN, Head Nurse, Department of Nursing, Pao-Chien Hospital, Taiwan, ROC.
MSN, RN, Supervisor, Department of Nursing, Pao- Chien Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2018 Oct;65(5):89-97. doi: 10.6224/JN.201810_65(5).11.
Rate of contamination is a well-known indicator of quality of care in the emergency department. Blood-culture results may affect clinical decision making. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital.
Using a quality improvement strategy, this project aimed to (1) identify potential factors contributing to the high blood culture contamination rate and (2) achieve a blood culture contamination rate below 3%.
The factors that were identified as potentially contributing to the high blood culture contamination rate were: (a) Nursing staff: lack of related education and training and ignorance of related clinical guidelines; (b) The system: inconsistent and non-evidence-based clinical guidelines (e.g., no requirement to use sterile gloves when obtaining blood cultures and changing disinfectants); (c) The patient: older patients, residents of long-term care facility, and patients whose blood culture were in the first set were associated with higher blood culture contamination rates. Our quality improvement strategy included: design a new bedside working plate, develop slogans and posters illustrating the proper blood-drawing procedure, make a video introducing current standard technology, provide continuing education, monitor contamination rates, and provide individual feedback and retraining for those with higher contamination rates.
The strategy was implemented from October 1, 2016 to December 31, 2016, during which period the blood culture contamination rate reduced from 5.63% to 1.51%.
Conclusion: Improving equipment, using multiple teaching methods, and providing regular feedback not only significantly reduced the blood culture contamination rate but also enhanced the knowledge and skills of nursing staff in terms of blood culture sampling. We hope that our results are referenced by other nursing departments and used to improve the blood culture contamination rates in other clinical settings.
污染率是急诊科医疗质量的一个众所周知的指标。血培养结果可能会影响临床决策。2015年1月1日至2015年12月31日，我院急诊科血培养污染率为5.63%，超过了美国微生物学会及我院临床实验室建议的最高值3%。
本项目采用质量改进策略，旨在（1）确定导致血培养污染率高的潜在因素，（2）使血培养污染率降至3%以下。
确定的可能导致血培养污染率高的因素有：（a）护理人员：缺乏相关教育和培训，对相关临床指南不了解；（b）制度：临床指南不一致且缺乏循证依据（如采集血培养标本时不要求使用无菌手套，消毒剂更换不规范）；（c）患者：老年患者、长期护理机构居民以及首次进行血培养的患者血培养污染率较高。我们的质量改进策略包括：设计新的床边操作板，制作说明正确采血程序的标语和海报，制作介绍当前标准技术的视频，提供继续教育，监测污染率，并对污染率较高的人员提供个人反馈和再培训。
该策略于2016年10月1日至2016年12月31日实施，在此期间血培养污染率从5.63%降至1.51%。
改进设备、采用多种教学方法并定期提供反馈不仅显著降低了血培养污染率，还提高了护理人员在血培养采样方面的知识和技能。我们希望其他护理部门能参考我们的结果，用于提高其他临床环境中的血培养污染率。
