title: Reducing blood culture contamination in a pediatric emergency department.
abstract: BACKGROUND
  Blood cultures (BCs) are used to diagnose bacteremia in febrile children. False-positive BCs increase costs because of further testing, longer hospital stays, and unnecessary antibiotic therapy. Data from a study at our hospital showed the emergency department consistently exceeded established guidelines of 2% to 4%. A phlebotomy policy change was made whereby BC had to be obtained by a second venipuncture and no longer obtained during insertion of intravenous catheters.
  
  
  METHODS
  A descriptive study compared preintervention and postintervention blood culture contamination (BCC) rates. A BC was considered contaminated if a single culture grew coagulase-negative staphylococci, diphtheroids, Micrococcus spp, Bacillus spp, or viridans group streptococci. Patients with indwelling central lines or who grew pathogenic bacteria were excluded.
  
  
  RESULTS
  Preintervention BCC was 120 (6.7% [SD, 2.3%]) of 1796. Postintervention BCC was 29 (2.3%, [SD, 0.8]) of 1229 with odds ratio of 2.96 (confidence interval, 1.96-4.57; P = 0.001). The most common contaminant was coagulase-negative staphylococcus, 21 (72%) of 120, followed by viridans streptococcus, 3 (10%) of 29, which was not significantly different between intervention periods. Before intervention, 44 patients were called back to the emergency department, and 25 were admitted because of BCC. After intervention, a total of 9 patients were called back, and 5 were admitted. The decrease in unnecessary hospitalization was statistically significant (P < 0.05).
  
  
  CONCLUSIONS
  The new policy significantly reduced BCC rates, thereby decreasing unnecessary testing and hospitalizations. Coagulase-negative staphylococci and viridans streptococci remain the most common BC contaminants. Further research should focus on additional interventions to reduce BCC.
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. gweddle@cmh.edu
authors.forename: Gina
authors.initials: G
authors.lastname: Weddle
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Selvarangan
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000175:diagnosis*; D001769:Blood / Q000382:microbiology*; D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards; D002406:Catheterization, Peripheral / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004866:Equipment Contamination / Q000517:prevention & control* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D018962:Phlebotomy / Q000592:standards*; D011050:Policy Making; D012189:Retrospective Studies; D055815:Young Adult