Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Qiaokou District, Wuhan, China.
Aust Crit Care. 2020 Nov;33(6):546-552. doi: 10.1016/j.aucc.2020.03.002. Epub 2020 May 13.
Blood culture contamination (BCC) is a safety and quality indicator for intensive care units (ICUs). BCC rates in our ICU ranged from 2.90% to 6.70% in 2017.
This quality improvement project aimed to reduce the contamination rate from a mean of 4.52% to <3.0% in 1 year by improving the adherence of nurses to the facility protocol during blood collection.
This project used a before-after design. It was conducted by a leadership team in a 32-bed ICU where approximately 4000 cultures are drawn annually. We observed the performance of ICU nurses during blood collection, interviewed them regarding the difficulties they encountered with protocol adherence, and conducted a cause-and-effect analysis to identify the main problems. Based on a literature review, we developed and implemented a countermeasure protocol, including a standardised medical order, an online learning program, a weekly departmental report and individual feedback routine, and phlebotomy training to address these problems in 2 months.
The interview results indicated that blood contamination resulted from the environment, difficult phlebotomy, and the inadequate knowledge and skill of the nurses. The countermeasure protocol reduced the average BCC rate from 4.52% to 2.59% during the intervention period and to 0.59% during the 10-month postintervention period. Nursing adherence to the standard protocol for blood culture collection also improved.
BCC in ICUs is multifactorial. By optimising the work environment, offering skill training, and reinforcing education and individualised feedback, we successfully reduced BCC in our unit to a sustainable low rate.
血培养污染（BCC）是重症监护病房（ICU）的安全和质量指标。2017 年，我们 ICU 的 BCC 率在 2.90%至 6.70%之间。
本质量改进项目旨在通过提高护士在采血过程中对设施方案的遵守程度，将污染率从平均 4.52%降低到 1 年内<3.0%。
本项目采用前后设计。由一个领导团队在一个有 32 张床的 ICU 中进行，该 ICU 每年抽取约 4000 个培养物。我们观察 ICU 护士在采血过程中的表现，就他们在遵守方案方面遇到的困难对他们进行采访，并进行因果分析，以确定主要问题。基于文献复习，我们制定并实施了一项对策方案，包括标准化医嘱、在线学习计划、每周部门报告和个人反馈常规以及采血培训，以在 2 个月内解决这些问题。
采访结果表明，血液污染是由环境、采血困难以及护士的知识和技能不足引起的。对策方案将平均 BCC 率从干预期间的 4.52%降低到干预后的 10 个月内的 2.59%，然后降低到 0.59%。护士对血液培养采集标准方案的遵守程度也有所提高。
ICU 中的 BCC 是多因素的。通过优化工作环境、提供技能培训、强化教育和个体化反馈，我们成功地将我们单位的 BCC 降低到可持续的低水平。
