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Kitted Out for Blood Cultures

Project Added:
11 February 2015
Last updated:
16 February 2015

Kitted Out for Blood Cultures

Summary

To reduce blood culture contamination rates at Campbelltown Hospital, a blood culture kit was introduced to the adult departments.

The project foundation is built on getting it right the first time and reducing unwarranted clinical variation by implementing one standardised kit with one set of instructions. This has embedded better practice focusing on aseptic technique.

This project was a finalist in the Harry Collins category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Aim

To reduce blood culture contamination rates, identify sepsis early and commence antimicrobial therapy.

Benefits

  • Improved patient outcomes through safe use of antibiotic treatments
  • Reduced risk of infection, hospital acquired infection and quicker patient recovery
  • More efficient blood test results and reduced length of hospital stay
  • Reduced unwarranted clinical variation.

Project status

Sustained: The project has been implemented, is sustained in standard business.

Background

The key to treatment of sepsis is early detection of the causative organism and commencement of appropriate antimicrobial therapy1. To ensure only the causative organism is cultured, it is imperative aseptic technique with the correct equipment is used to collect the blood sample.

A blood culture is the primary laboratory test for diagnosing blood stream infections, including sepsis, and guides the commencement of appropriate antibiotic therapy.

False positive blood cultures may result in delayed treatment whilst repeat samples are taken and the prescription of unnecessary antibiotics.

Overuse or inappropriate use of antibiotics can result in development of multi drug resistance. The increase in bacterial antibiotic resistance is of global concern and studies show that up to 50% of antimicrobial regimes prescribed in hospitals are considered inappropriate2.

Implementation 

The project involved recognition of the causal factors of contaminates in blood cultures in the facility. The causal factors included:

  1. Ready access to equipment necessary for obtaining blood cultures
  2. Lack of consistency in use of equipment to obtain blood cultures
  3. No standardised technique for obtaining blood cultures, which significantly impacted on aseptic technique and subsequent false positive results
  4. Rotation of medical staff throughout the facility influenced procedure variation

The creation of the blood culture kits provided the solution to the problems identified and included: 

  1. One standardised kit available in all adult inpatient units
  2. One set of equipment including one skin aseptic solution pack per kit
  3. A key element embedded in the innovation is aseptic technique. The instruction leaflet addresses this and aims to standardise practice and technique
  4. The ease of access to the kit has reduced the potential risk of clinicians introducing variables to the technique of obtaining blood cultures.

The kits contains: A specimen bag containing a safety blood collection cannula, a vacutainer, a pack of three chlorhexidine and alcohol swabsticks, sterile gauze, disposable tourniquet, and blood culture bottles with a ten step instruction leaflet ‘How to Take a Blood Culture’, detailing when hand hygiene must be performed and adherence to aseptic technique plus a kit contents list. In 2013, a sterile drape was added to provide a sterile field.

The pathology department manages the distribution of the kits to ensure maintenance of stock levels.

In April 2012, the kits were implemented in the adult departments in the facility. Clinicians readily accepted them and their use has become standard practice for obtaining blood cultures in adult departments.

Rotation of staff in public hospitals is routine and provision of a standardised blood culture kit has a number of advantages for the patient and the facility. These include: preventing the commencement of incorrect antibiotics, decrease waste of equipment, (only one of everything is provided) and fewer repeat tests required. 

Departments not using the kits have seen the outcome data and are now reviewing their blood culture contamination rates, aseptic and procedural technique, with a view to implementing the kits.

Awareness of the effectiveness of this project provided impetus to the emergency department to embark on a targeted project, to reduce their blood culture contamination rate. The essential component of the blood culture kit, is chlorhexidine/alcohol swabs, these were made readily available in the emergency department as it was found the difference between the emergency department and inpatient units, using the kits, was the type of skin preparation used. A decrease in contamination occurred, confirming skin preparation is central to decreasing contamination rates.

The infectious diseases physicians have reported a decrease in consultations from Campbelltown, regarding advice for antibiotic therapy based on false positive blood culture results.

Many clinicians on rotation from other hospitals, have enquired if the kits are available at other hospitals as they found them to be a valuable tool in clinical care.

Results 

This program has reduced the number of contaminated blood cultures. The risk of patients acquiring an Hospital Associated Infection has reduced as less venepunctures are required and the risk of acquiring Clostridium difficile is reduced with administration of the correct antibiotic.

This project has improved clinicians awareness and compliance to aseptic technique and has resulted in effectively decreasing the blood culture contamination rates from 44.4% (229) in 2011- 2012 to 30.5% (167) in 2013 – 2014.

Obtaining accurate microbiology results have improved patient outcomes. The simplicity of the blood culture kit has resulted in subsequent positive outcomes which gave been reliably sustained since April 2012.

Improvements obtained from implementation of the kits are reported to the relevant teams and results are reported monthly to the Infection Prevention Committee. This reflects the facility commitment to openness.

Feedback on improved contamination rates empowers and drives the clinicians to improve the high standard of care.

Patients gain confidence and respect when they receive a high standard of efficient care.

Lessons Learnt 

It was found the difference between the emergency department and inpatient units, using the kits, was the type of skin preparation used. A decrease in contamination occurred, confirming skin preparation is central to decreasing contamination rates.

The teamwork began with the Infection Prevention Committee identifying an opportunity to improve clinical practice.

Working for a common goal brings staff together and leads to improved practice. As the kit became known for its success in the adult departments, other teams joined forces to continue the success of the innovation.

Patients observe the use of kits and should a clinician attempt to obtain a culture without the kit the patient has been known to remind them of the kits existence, thus demonstrating an ideal partnership.

References

  1. Croft AC, Woods GL. Specimen collection and handling for diagnosis of infectious diseases. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Philadelphia, Pa: Saunders Elsevier; 2011: Chap 63.
  2. Australian Commission on Safety and Quality in Health Care. Safety and Quality Improvement Guide Standard 3: Preventing and Controlling Healthcare Associated Infections (October 2012). Sydney. ACSQHC, 2012.

Contact

Michelle Callard
Infection Prevention Clinical Nurse Consultant
South Western Sydney Local Health District (SWSLHD)
Phone: 02 4634 3788
Email: Michelle.Callard@sswahs.nsw.gov.au

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