title: Reducing blood culture contamination by a simple informational intervention.
abstract: Compared to truly negative cultures, false-positive blood cultures not only increase laboratory work but also prolong lengths of patient stay and use of broad-spectrum antibiotics, both of which are likely to increase antibiotic resistance and patient morbidity. The increased patient suffering and surplus costs caused by blood culture contamination motivate substantial measures to decrease the rate of contamination, including the use of dedicated phlebotomy teams. The present study evaluated the effect of a simple informational intervention aimed at reducing blood culture contamination at Skåne University Hospital (SUS), Malmö, Sweden, during 3.5 months, focusing on departments collecting many blood cultures. The main examined outcomes of the study were pre- and postintervention contamination rates, analyzed with a multivariate logistic regression model adjusting for relevant determinants of contamination. A total of 51,264 blood culture sets were drawn from 14,826 patients during the study period (January 2006 to December 2009). The blood culture contamination rate preintervention was 2.59% and decreased to 2.23% postintervention (odds ratio, 0.86; 95% confidence interval, 0.76 to 0.98). A similar decrease in relevant bacterial isolates was not found postintervention. Contamination rates at three auxiliary hospitals did not decrease during the same period. The effect of the intervention on phlebotomists' knowledge of blood culture routines was also evaluated, with a clear increase in level of knowledge among interviewed phlebotomists postintervention. The present study shows that a relatively simple informational intervention can have significant effects on the level of contaminated blood cultures, even in a setting with low rates of contamination where nurses and auxiliary nurses conduct phlebotomies.
authors.affiliation: Department of Medical Microbiology, Skåne University Hospital, SUS Malmö 20502, Sweden. adam.roth@med.lu.se
authors.forename: A
authors.initials: A
authors.lastname: Roth
authors.forename: A E
authors.initials: AE
authors.lastname: Wiklund
authors.forename: A S
authors.initials: AS
authors.lastname: Pålsson
authors.forename: E Z
authors.initials: EZ
authors.lastname: Melander
authors.forename: M
authors.initials: M
authors.lastname: Wullt
authors.forename: J
authors.initials: J
authors.lastname: Cronqvist
authors.forename: M
authors.initials: M
authors.lastname: Walder
authors.forename: E
authors.initials: E
authors.lastname: Sturegård
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001431:Bacteriological Techniques / Q000379:methods*; D001769:Blood / Q000382:microbiology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis*; D013048:Specimen Handling / Q000379:methods*; D013548:Sweden