title: Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device.
abstract: BACKGROUND
  Blood culture contamination is a clinically significant problem that results in patient harm and excess cost.
  
  
  METHODS
  In a prospective, controlled trial at an academic center Emergency Department, a device that diverts and sequesters the initial 1.5-2 mL portion of blood (which presumably carries contaminating skin cells and microbes) was tested against standard phlebotomy procedures in patients requiring blood cultures due to clinical suspicion of serious infection.
  
  
  RESULTS
  In sum, 971 subjects granted informed consent and were enrolled resulting in 904 nonduplicative subjects with 1808 blood cultures. Blood culture contamination was significantly reduced through use of the initial specimen diversion device™ (ISDD) compared to standard procedure: (2/904 [0.22%] ISDD vs 16/904 [1.78%] standard practice, P = .001). Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P = .41. No needlestick injuries or potential bloodborne pathogen exposures were reported. The monthly rate of blood culture contamination for all nurse-drawn and phlebotomist-drawn blood cultures was modeled using Poisson regression to compare the 12-month intervention period to the 6 month before and after periods. Phlebotomists (used the ISDD) experienced a significant decrease in blood culture contamination while the nurses (did not use the ISDD) did not. In sum, 73% of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted.
  
  
  CONCLUSIONS
  Use of the ISDD was associated with a significant decrease in blood culture contamination in patients undergoing blood cultures in an Emergency Department setting.
  
  
  BACKGROUND
  NCT02102087.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.affiliation: Division of Infectious Diseases.
authors.forename: R Jennifer
authors.initials: RJ
authors.lastname: Cavalieri
authors.affiliation: Division of Infectious Diseases.
authors.forename: Cole
authors.initials: C
authors.lastname: Marolf
authors.affiliation: Department of Epidemiology, University of Nebraska Medical Center, Omaha.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
mesh_terms: D016470:Bacteremia / Q000382:microbiology; D000071997:Blood Culture / Q000379:methods*; D001800:Blood Specimen Collection / Q000295:instrumentation* / Q000379:methods; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004866:Equipment Contamination / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D018962:Phlebotomy / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies
keywords: blood culture; contamination; initial specimen diversion device