title: Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care.
abstract: Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher's exact test: P = 0.0259). No dermatological sequelae were observed. The improvement has been sustained.
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: O'Connor
authors.affiliation: Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland.
authors.forename: R K
authors.initials: RK
authors.lastname: Philip
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Powell
authors.affiliation: Infection Prevention & Control Team, University Hospital Limerick, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Slevin
authors.affiliation: Department of Paediatrics (Division of Neonatology), University Maternity Hospital, Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Quinn
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Power
authors.affiliation: Department of Clinical Microbiology, University Hospital Limerick, Ireland; Infection Prevention & Control Team, University Hospital Limerick, Ireland; Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland.
authors.forename: N H
authors.initials: NH
authors.lastname: O'Connell
authors.affiliation: Centre for Intervention in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland. Electronic address: colum.dunne@ul.ie.
authors.forename: C P
authors.initials: CP
authors.lastname: Dunne
mesh_terms: D019840:2-Propanol / Q000008:administration & dosage; D000985:Antisepsis / Q000379:methods*; D000071997:Blood Culture / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004501:Education, Medical; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D018962:Phlebotomy / Q000379:methods*; D012867:Skin / Q000382:microbiology*; D013048:Specimen Handling / Q000379:methods*
chemical_list: C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine
keywords: Bacteria; Blood culture; Chlorhexidine; Contamination; Intervention; Neonatal