From the Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota (Dr Syed); the Department of Medicine (General Internal Medicine and Geriatrics), Northwestern Feinberg School of Medicine, Chicago, Illinois (Dr Liss); and the Sections of Infectious Disease (Dr Costas) and Laboratory Department (Dr Atkinson), Amita Health Saint Francis Hospital Evanston, and Medical Affairs, Alverno Laboratories for Legacy Presence Hospitals (Dr Atkinson), Evanston, Illinois.
Arch Pathol Lab Med. 2020 Feb;144(2):215-220. doi: 10.5858/arpa.2018-0524-OA. Epub 2019 Jul 11.
CONTEXT.—: Blood culture contamination is a common problem faced by medical centers and leads to significant cost. A possible method to reduce contamination is to discard the initial aliquot of blood, which contains skin and bacteria.
OBJECTIVE.—: To determine whether the rate of contaminant blood cultures could be reduced by changing the order of draw to divert the first 7 mL to a gold- or green-top tube.
DESIGN.—: A preintervention and postintervention study was conducted. During the 18-month intervention phase (September 2015-February 2017), all nurses in the emergency department and inpatient floor phlebotomists collected blood cultures by drawing the first 7 mL of blood into a gold- or green-top tube followed by drawing blood for blood culture bottles. The 18 months immediately preceding the study period (February 2014-July 2015) were used for comparison.
RESULTS.—: There was an overall statistically significant decrease in contamination rate from 2.46% in the prediversion protocol group to 1.70% in the postdiversion protocol group ( < .001). Emergency department drawn cultures and inpatient cultures showed significant decrease in contamination rates between the preprotocol and postprotocol groups, 2.92% versus 1.95% ( < .001) for emergency department, and 1.82% versus 1.31% ( = .03) for inpatient. We noted less month-to-month variation during the study period compared with the preintervention period.
CONCLUSIONS.—: By using this simple diversion method, we were able to improve blood culture contamination rates for our emergency department and inpatients while incurring no added cost to the procedure.
血培养污染是医疗中心面临的一个常见问题，会导致巨大的成本。减少污染的一种可能方法是丢弃最初的血液样本，因为其中含有皮肤和细菌。
确定通过改变采血顺序，将最初的 7 毫升血液转移到金顶或绿顶管中，是否可以降低污染血培养的发生率。
进行了一项预干预和后干预研究。在 18 个月的干预阶段（2015 年 9 月至 2017 年 2 月），急诊科和住院病房的所有护士和采血师在采集血培养标本时，先将最初的 7 毫升血液转移到金顶或绿顶管中，然后再采集血液用于血培养瓶。将研究前的 18 个月（2014 年 2 月至 2015 年 7 月）用作比较。
在预分流方案组中，污染率总体上从 2.46%显著降低至后分流方案组的 1.70%（<0.001）。在预方案组和后方案组之间，急诊和住院患者的血培养标本污染率均显著降低，急诊分别为 2.92%和 1.95%（<0.001），住院分别为 1.82%和 1.31%（=0.03）。与干预前相比，我们在研究期间注意到每月的变化较小。
通过使用这种简单的分流方法，我们能够提高急诊科和住院患者的血培养污染率，同时不会增加该程序的成本。
