Kumthekar Isha, Urs Tejashree, Rajashekar Deepashree, Karthik Krishna
Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, IND.
Cureus. 2024 Feb 9;16(2):e53941. doi: 10.7759/cureus.53941. eCollection 2024 Feb.
Introduction and methods Blood culturing has become one of the backbone investigations for septicemia, fever of unknown origin, etc. This study was conducted to test the effect of multimodal interventions on the practical skills of healthcare workers (HCWs), raise awareness regarding the importance of aseptic blood culture collection practices, and increase compliance with the specific steps to be followed. Hence, this current interventional study was aimed at comparing the rate of isolation of contaminants grown among the blood culture specimens, assessing the knowledge, attitude, and practice (KAP) of HCWs collecting the blood culture specimen on various aspects of sample collection, educating the nursing staff regarding blood sample collection using a structured, pre-formed checklist, and emphasizing best practices for blood culture collection. All of the study's objectives were successfully met within the time frame specified. Using a pre-formed checklist and a Google form for KAP analysis eased the calculation. Results On analysis, the blood culture contamination rate in the pre-interventional phase dropped drastically from 6.16% to 3.03% in the post-interventional phase. The educational sessions conducted are a paramount reason for the reduction in the contamination rate. The HCWs were the least compliant towards the eighth step in the checklist (regarding palpation of skin); however, that too increased from 66.93% and 64.51% to a whopping 82.25% and 83.06%, respectively, with a chi-square value of 0.03 and a p-value of 0.85 (not significant). Conclusion Implementation of interventional studies as an audit like this in tertiary care hospitals can result in a significant reduction in blood culture contamination rates and can also improve the compliance of HCWs with blood culture protocols. This, in turn, can overall improve the effectiveness of blood culture (BC) testing and reduce mortality and morbidity in tertiary care hospitals. Further research can be conducted to brainstorm more methods to increase the compliance of HCWs. Better monitoring strategies can also be set to ensure low contamination rates. Additionally, some other methods can be derived to locate the source of contamination within the hospital environment and thus eliminate it. Similar interventions can be conducted for a longer duration of time to further reduce the blood culture contamination rate below 3% (as per the recommendations).
引言与方法 血培养已成为败血症、不明原因发热等疾病的主要检查手段之一。本研究旨在测试多模式干预对医护人员实践技能的影响，提高对无菌血培养采集操作重要性的认识，并提高对特定操作步骤的依从性。因此，本项干预性研究旨在比较血培养标本中污染菌的分离率，评估采集血培养标本的医护人员在样本采集各方面的知识、态度和实践情况，使用结构化的预形成检查表对护理人员进行血样采集教育，并强调血培养采集的最佳实践。在规定的时间范围内，该研究的所有目标均成功实现。使用预形成检查表和谷歌表单进行知识、态度和实践分析简化了计算过程。
结果 分析发现，干预前阶段的血培养污染率从6.16%大幅降至干预后阶段的3.03%。所开展的教育培训是污染率降低的首要原因。医护人员对检查表中的第八步（皮肤触诊）依从性最低；不过，这一步的依从率也分别从66.93%和64.51%大幅提高到了82.25%和83.06%，卡方值为0.03，p值为0.85（无显著性差异）。
结论 在三级医院开展此类作为审核的干预性研究，可显著降低血培养污染率，还能提高医护人员对血培养规程的依从性。这反过来可全面提高血培养检测的有效性，降低三级医院的死亡率和发病率。可开展进一步研究，集思广益，探讨更多提高医护人员依从性的方法。还可制定更好的监测策略，确保低污染率。此外，可采用其他方法确定医院环境中的污染源并加以消除。可在更长时间内开展类似干预，以进一步将血培养污染率降至3%以下（根据建议）。
