title: Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study.
abstract: OBJECTIVE
  Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED.
  
  
  METHODS
  The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university-affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48-week baseline period (clean technique) and 48-week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first-order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%.
  
  
  RESULTS
  During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period.
  
  
  CONCLUSIONS
  A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.
authors.affiliation: Department of Emergency Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA. wesley.self@vanderbilt.edu
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.forename: Jacki
authors.initials: J
authors.lastname: Ashburn
authors.forename: Dandan
authors.initials: D
authors.lastname: Liu
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Stephan
authors.initials: S
authors.lastname: Russ
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
mesh_terms: D000985:Antisepsis / Q000379:methods*; D001769:Blood / Q000382:microbiology*; D001800:Blood Specimen Collection / Q000009:adverse effects* / Q000379:methods*; D002710:Chlorhexidine / Q000494:pharmacology; D004636:Emergency Service, Hospital; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement; D014481:United States
chemical_list: D002710:Chlorhexidine