Laboratory, Armed Forces Hospital Jizan, Jizan, Saudi Arabia
Medical Laboratory, Armed Forces Hospital Jizan, Jizan, Saudi Arabia.
BMJ Open Qual. 2023 Jan;12(1). doi: 10.1136/bmjoq-2022-002150.
Blood culture contamination (BCC) is a significant quality and safety issue in hospitals, as it leads to increase in unnecessary testing, admissions, antibiotic exposure and cost. This study is the first study on the BCC rates in Armed Forces Hospital Jizan (AFHJ), Saudi Arabia. The main goal of our quality improvement (QI) project was to reduce BCC rate in AFHJ from 7.5% to international benchmark (<3%) after January 2021 as well as to reduce the negativity rate. This study was conducted in AFHJ (KSA) including two major steps: first, development and implementation of QI interventions to reduce BCC and negativity rate in the AFHJ. Second, evaluation of the effectiveness of these interventions. The intervention was developed through QI methodologies, including fishbone diagramming and the plan-do-study-act cycle. Intervention effectiveness was evaluated using an interrupted time series analysis. Clear survey questionnaires were made and distributed to participants to get preaudit results.Then we started the education programme depending on the preaudit results. Soft copy of written steps of blood collection procedure and indication was done and sent to nurses and physicians. After that, direct observations of nurses involved in the process were conducted. Finally, post-training assessment using previous survey questionnaires was performed to get postaudit results. During the baseline period (preintervention period), 7.5% from blood culture were contaminated, compared with 1.8% during the intervention period (postintervention period). Rate of negative blood culture was reduced from 96% to 91%. Overall improvement of knowledge and awareness of the nurses and physicians clearly noted after intervention implementation. Fortunately, we have noted that the budget of microbiology would be reduced by 10%-12% as a result of our interventions. By standardising blood culture collection methods, optimising blood volume and nurses' education, we were able to develop a best practice for blood culture collection and to reduce BCC and negativity rate to a sustainable low rate at our hospital.
血培养污染（BCC）是医院中一个重大的质量和安全问题，因为它会导致不必要的检测、住院、抗生素暴露和成本增加。这项研究是沙特阿拉伯吉赞武装部队医院（AFHJ）首次进行的血培养污染率研究。我们的质量改进（QI）项目的主要目标是在 2021 年 1 月之后将 AFHJ 的血培养污染率从 7.5%降低至国际基准（<3%），并降低阴性率。这项研究在 AFHJ（沙特阿拉伯）进行，包括两个主要步骤：首先，开发和实施 QI 干预措施，以降低 AFHJ 的血培养污染率和阴性率。其次，评估这些干预措施的效果。通过 QI 方法，包括鱼骨图和计划-实施-研究-行动循环，制定了干预措施。通过中断时间序列分析评估干预措施的有效性。制定了明确的调查问卷并分发给参与者以获得预审计结果。然后根据预审计结果开始教育计划。完成了血样采集程序和指示的书面步骤的软拷贝，并分发给护士和医生。之后，对参与该过程的护士进行了直接观察。最后，使用之前的调查问卷进行培训后评估，以获得后审计结果。在基线期（干预前），7.5%的血培养标本被污染，而干预期（干预后）则为 1.8%。阴性血培养率从 96%降至 91%。干预实施后，护士和医生的知识和意识明显提高。幸运的是，我们注意到由于我们的干预措施，微生物学的预算将减少 10%-12%。通过标准化血培养采集方法、优化血容量和护士教育，我们能够为血培养采集制定最佳实践，并将 BCC 和阴性率降低到我们医院的可持续低水平。
