Mullane Niamh, O'Mara Niall, Coffey Darragh, Connolly Aine, O'Callaghan Isabelle, Kelly Deborah, Broderick Deirdre, Hickey Caitriona
Department of Clinical Microbiology, Cork University Hospital, Wilton, Cork, Ireland.
Access Microbiol. 2024 Jul 2;6(7). doi: 10.1099/acmi.0.000806.v3. eCollection 2024.
Blood culture contamination (BCC) is an important quality concern in clinical microbiology as it can lead to unnecessary antimicrobial therapy in patients and increased workload for laboratory scientists. The Clinical Laboratory and Standards Institute recommend BCC rates to be <3 % and recently updated guidelines have set a new goal of 1 %. The aim of this project was to design and implement interventions to reduce BCC rates at our institution. We introduced a combined education and skin antisepsis intervention in a large Model 4 academic teaching hospital in the South of Ireland. BD ChloraPrep skin antisepsis applicators (2 % chlorhexidine gluconate/70 % isopropyl alcohol), licensed for use for blood culture specimen collection, were introduced, replacing Clinell (2 % chlorhexidine gluconate/70 % isopropyl alcohol) wipes. In addition, a multimodal education programme was designed and delivered. This consisted of a video demonstrating the recommended blood culture specimen collection technique using the new applicators as well as simulation training for all interns. The video was uploaded to the intranet as an educational resource available to all staff. The interventions were implemented in July 2022 and BCC rates pre- and post-intervention were calculated. The average BCC rate for the 12 months preceding the intervention (July 2021 to July 2022) was 2.56 % with highest rates in the Emergency Department. This compared to an average rate of 2.2 % in the 12 months post-intervention (July 2022 to July 2023). In comparing the two rates the reduction in BCC rates between the two periods was not statistically significant (=0.30). Overall BCC rates reduced but the difference between the two periods did not reach statistical significance. The resource-intensive nature of providing regular and timely feedback of contamination rates and the larger impact of in-person education and training over virtual modalities may explain the modest reduction. Further investments in these areas, particularly in the Emergency Department, will be necessary to further reduce rates in line with new recommendations.
血培养污染（BCC）是临床微生物学中一个重要的质量问题，因为它可能导致患者接受不必要的抗菌治疗，并增加实验室科学家的工作量。临床实验室标准协会建议BCC发生率应<3%，最近更新的指南设定了1%的新目标。本项目的目的是设计并实施干预措施，以降低我们机构的BCC发生率。我们在爱尔兰南部一家大型4型学术教学医院引入了一项结合教育和皮肤消毒的干预措施。引入了经许可用于血培养标本采集的BD ChloraPrep皮肤消毒涂抹器（2%葡萄糖酸氯己定/70%异丙醇），取代了Clinell（2%葡萄糖酸氯己定/70%异丙醇）擦拭巾。此外，还设计并实施了一个多模式教育项目。该项目包括一个视频，展示了使用新涂抹器进行血培养标本采集的推荐技术，以及为所有实习生提供模拟培训。该视频作为教育资源上传到内联网，供所有员工使用。干预措施于2022年7月实施，并计算了干预前后的BCC发生率。干预前12个月（2021年7月至2022年7月）的平均BCC发生率为2.56%，急诊科发生率最高。相比之下，干预后12个月（2022年7月至2023年7月）的平均发生率为2.2%。比较这两个发生率，两个时期BCC发生率的降低没有统计学意义（P=0.30）。总体BCC发生率有所降低，但两个时期之间的差异未达到统计学意义。提供污染率定期及时反馈的资源密集性质，以及面对面教育和培训比虚拟方式产生的更大影响，可能解释了降低幅度不大的原因。有必要在这些领域进一步投入，特别是在急诊科，以根据新建议进一步降低发生率。
