| Principal Investigator: | Meghann McConnell, RN |
| Co-Principal Investigators/Collaborators: | Vicki Lawhern, Vicktoria Danilova, Linda McKinley |
| Organization: | William S. Middleton Memorial VA Hospital |
Abstract
Problem
From January through July of 2008 the monthly blood culture collection contamination rate of the William S. Middleton Memorial VA Hospital ranged between 1.3-4.2%. The Veterans Integrated Service Network for the Great Lakes Area (VISN 12) recommends a contamination rate of no more than 2.5% hospital-wide. Contaminated samples result in poor patient care associated with prolonged hospital stays, unneeded antibiotics, and extensive further testing. In addition, this correlates to an estimated $5,000-$8,000 loss with each contaminated blood culture.
Evidence
Examination of current practices in place at the William S. Middleton Memorial VA Hospital, evidenced based current protocol recommendations, and collaboration with infection control and the microbiology laboratory linked contamination to five possible areas: personnel training, location of collection, site cleaning, collection equipment, and collection volume.
Strategy
A survey was conducted of the nurses on staff (n=168); 42% were returned. Scores revealed a deficit in knowledge of proper blood culture collection (60.5%). In-services were given to nurses regarding new protocol procedures; attendance (n=168) was 38%.
Practice Change
Specific knowledge deficits were identified and the staff was educated regarding: the use of PIV and newly inserted angiocaths is an unacceptable method of blood culture collection, proper site use and disinfection, proper use of collection equipment, adequate volume of blood in each sample, and charting and labeling of the samples.
Evaluation
The average post in-service scores on the survey for the staff nurses (n=168) was 92.8%. High scores demonstrated retained knowledge of proper blood collection protocol.
Results
Lower monthly contamination rates were recorded following the educational sessions, but still fluctuated between 1.7%-3.6% from August through December of 2008.
Recommendations
Further collection protocol in-services are recommended. A tracking sheet is being designed to identify collectors that require further education as well.
Lessons Learned
Change takes time and persistence. As long as lower contamination rates are pursued and proper collection protocol is insisted upon patient care and resource utilization can improve.
Bibliography
- Bekeris, L. G., Tworek, J. A., Walsh, M. K., & Valenstein, P. N. (2005, October). Trends in Blood Culture Contamination. Archives of Pathology and Laboratory Medicine, 120, 1222–1225. Retrieved June 25, 2008, from CINAL database.
- Donnino, M. W., Goyal, N., Terlecki, T. M., Donnino, K. F., Miller, J. B., Otero, R. M., et al. (2007, September). Inadequate Blood Volume Collected for Culture: A Survey of Health Care Professionals. Mayo Clinic Proceedings, 82(9), 1069–1072. Retrieved June 25, 2008, from CINAL database.
- Ernst, D. J. (2004, March). Controlling Blood-Culture Contamination Rates. Medical Laboratory Observer, 14–18. Retrieved June 25, 2008, from CINAL database.
- Lippincot, Williams, & Wilkins. (2005). Blood Culture [Procedure Protocol for Blood Culture Collection]. Retrieved July 25, 2008, from VA Hospital Web site.
- Ogden-Grable, H. (2004, June). Blood Culture Contamination Tips [Letter to the editor]. Medical Laboratory Observer, 4–5. Retrieved June 25, 2008, from CINAL database.