Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device

Mark Edmund Rupp, R. Jennifer Cavalieri, Cole Marolf, Elizabeth Lyden

Research output: Contribution to journalArticle

14 Citations (Scopus)

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. Clinical Trials Registration. NCT02102087.

Original languageEnglish (US)
Pages (from-to)201-205
Number of pages5
JournalClinical Infectious Diseases
Volume65
Issue number2
DOIs
StatePublished - Jul 15 2017

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Equipment and Supplies
Hospital Emergency Service
Nurses
Blood-Borne Pathogens
Patient Harm
Needlestick Injuries
Blood Culture
Phlebotomy
Bacteremia
Informed Consent
Clinical Trials
Costs and Cost Analysis
Skin
Infection

Keywords

  • blood culture
  • contamination
  • initial specimen diversion device.

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. / Rupp, Mark Edmund; Cavalieri, R. Jennifer; Marolf, Cole; Lyden, Elizabeth.

In: Clinical Infectious Diseases, Vol. 65, No. 2, 15.07.2017, p. 201-205.

Research output: Contribution to journalArticle

Rupp, Mark Edmund ; Cavalieri, R. Jennifer ; Marolf, Cole ; Lyden, Elizabeth. / Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 2. pp. 201-205.
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