title: Blood culture contamination rate in an intensive care setting: Effectiveness of an education-based intervention.
abstract: BACKGROUND
  Blood culture (BC) contamination rate is an indicator of quality of care scarcely explored in intensive care units (ICUs). We analyzed the BC contamination rate in our ICU to assess the effectiveness of an education-based intervention.
  
  
  METHODS
  We conducted an interventional study with concurrent controls. Consecutive BCs drawn during a 6-month period were included. An education-based intervention was presented to case nurses (optimal technique). The remaining nurses comprised the control group (standard technique). Two independent observers assessed clinical significance of saprophytic skin bacteria isolated in BCs.
  
  
  RESULTS
  Six hundred fifty-six BCs were obtained: 308 (47%) via optimal technique and 348 (53%) via standard technique (47%). One hundred eighty-seven BCs were positive for saprophytic microorganisms; 127 (89%) were considered unrelated to infection. Coagulase-negative staphylococci isolation was lower in the optimal technique group (14% vs 26%; P < .001), as well as contamination due to coagulase-negative staphylococci (12% vs 21%; P = .002) or Acinetobacter baumannii (0.3% vs 2%; P = .013). BC contamination rate was 13% in the optimal technique group versus 23% in the standard group (P < .005). In the optimal technique group, BC contamination rate was higher in BCs drawn through the catheter (17% vs 7%; P = .028).
  
  
  CONCLUSIONS
  An education-based intervention significantly reduced the BC contamination rate in our ICU. It seems necessary to design a tool to extract BCs through the catheter to minimize the risk of contamination.
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain; CIBERES (Research Center for Respiratory Pathologies) Instituto de Salud Carlos III, Madrid, Spain. Electronic address: ramirez_pau@gva.es.
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Gordón
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Cortes
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Villarreal
authors.affiliation: Microbiology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Perez-Belles
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Robles
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: de Hevia
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Jose Vicente
authors.initials: JV
authors.lastname: Marti
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Botella
authors.affiliation: Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
mesh_terms: D016470:Bacteremia / Q000175:diagnosis*; D001521:Behavior Therapy; D001769:Blood / Q000382:microbiology*; D003422:Critical Care / Q000379:methods*; D004501:Education, Medical; D004866:Equipment Contamination; D005189:False Positive Reactions; D006801:Humans; D011446:Prospective Studies; D013048:Specimen Handling / Q000379:methods*
keywords: Coagulase-negative staphylococci; Critical care; False positive blood cultures