努力通过减少急诊科血培养污染来改善菌血症的诊断：策略和结果。

Efforts to improve diagnosis of bacteraemia by reducing blood culture contamination in an emergency department: strategies and outcome.

机构信息

Aga Khan Hospital, Karachi, Pakistan.

Armed forces Hospital, Khamis Al-Mushyt, Saudi Arabia.

出版信息

J Pak Med Assoc. 2020 May;70(5):835-839. doi: 10.5455/JPMA.12462.

DOI:10.5455/JPMA.12462

PMID:32400737

Abstract

OBJECTIVE

To assess the strategies and outcome for reducing blood culture contamination in order to improve the diagnosis of bacteraemia.

METHODS

The interventional study was conducted at a tertiary care hospital in Karachi from January 1, 2013, to December 31, 2016. The blood culture contamination data related to the first year of the study was taken as the baseline pre-intervention data. Strategies were planned as intervention for improvement by consolidating training and education in the form of dedicated lectures, practising on mannequins and developing in-house video, replacing povidone with 2% chlorhexidine preparation spray plus 70% isopropyl alcohol swabs and inducting dedicated phlebotomy team whose only responsibility was blood sample collection and minimising the probability of error.

RESULTS

In 2013, there were 8868 samples; 7402 in 2014; 6897 in 2015; and 9756 samples in 2016. The contamination rate in 2013 was 8% which went down to 7.75% in 2014, 4.25% in 2015 and 3.9% in 2016. The decline became statistically significant (p<0.001) after implementing a dedicated phlebotomy team in the emergency department.

CONCLUSIONS

Apart from teaching and training, the concept of blood culture collection kit with checklist and dedicated blood collection team was found to be vital in reducing blood culture contamination.

摘要

目的

评估降低血培养污染率的策略和结果，以提高菌血症的诊断水平。

方法

这项干预研究于 2013 年 1 月 1 日至 2016 年 12 月 31 日在卡拉奇的一家三级护理医院进行。将研究第一年的血培养污染数据作为基线预干预数据。通过整合专门的讲座、在模拟人身上练习以及制作内部视频等形式的培训和教育，规划了提高污染率的策略，还更换了聚维酮碘为 2%洗必泰准备喷雾加 70%异丙醇棉签，并引入了专门的采血团队，该团队的唯一职责是采集血样，尽量减少出错的可能性。

结果

2013 年有 8868 个样本；2014 年有 7402 个样本；2015 年有 6897 个样本；2016 年有 9756 个样本。2013 年的污染率为 8%，2014 年降至 7.75%，2015 年降至 4.25%，2016 年降至 3.9%。在急诊科引入专门的采血团队后，下降趋势具有统计学意义（p<0.001）。