Blood Culture Contamination Rate Reduction; A Quality Improvement Plan in the ED
Michelle Deane RN and Cat Citron BSN RN
                                         Background
Abstract
             Blood culture contamination rates have affected the
cost of care for our patients in a negative way. It impacts the
cost of the inpatient visit, can led to misdiagnosis, and
patients can be exposed to unnecessary antibiotic exposure
(CDC, 2023). We all know the importance of early sepsis
interventions along with appropriate antibiotic therapy.
However mishandling and improper technique can allow for a
decrease in cost effectiveness along with quality of care.
Misuse of antibiotics can lead to an increase in antibiotic
resistant organisms along with an increase in the cost of
treatment for the patient and hospital (Yahav et al., 2021).
Having a strong guidelines in obtaining blood cultures can
help decrease the cost and length of stay for the patient.
                               Introduction
Introduction
            In November 2022, our contamination rates were
listed, and a trend was noted our ED nurses were having an
increase in blood culture contamination rates upwards of
70%.  This increase in contamination rate caused an increase
in the cost of care for the patient and length of stay. Our
unit's  increase in contamination rates allowed for us to
implement this quality improvement project where we tested
different strategies to help decrease contamination rates. We
focused on increasing education and awareness, creating a
buddy check system, along with utilizing sterile techniques
with ultrasound guided IVs.
Bon Secours Memorial College of Nursing
Blood Culture Contamination Rates Pre and Post
Buddy System
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10
0 had throughout the project was teamwork. Many of the staff
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Method
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Series 1
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        We expanded educational information to all staff but targeted
the six lowest rated nurses and focused in on them throughout the
implementation. We increased daily educational pointers on
effective blood culture collection practices. We conducted a buddy
system where there was a second set of eyes and assistive hands
throughout the procedure. During ultrasound IV insertions, we used
certain sterile techniques such as, sterile gloves and sterile jelly. We
conducted this study from 2/01-3/8 of 2023 
Results
            Increasing education garnered mixed results as some
of the techniques we used had little to no effect on
decreasing the blood culture contamination rate. Many
nurses were able to however, decrease their overall blood
culture contamination rate with the utilization of the buddy
system. This not only helped decrease contamination rates, it
also helped increase teamwork. Using sterile techniques or
equipment also was challenging and garnered fair results
with approximately 30% of nurses decreasing
their contamination rates. The biggest unintentional result
garnered throughout this quality improvement plan was the
theme of teamwork and togetherness  
       During our quality improvement project, we noticed that
there were barriers that limited us throughout the project.
The lack of supplies was one main issue as we needed to
always maintain a certain amount on hand. We attempted to Although the main goal of reducing blood culture
contamination rates garnered mixed results, it allowed the
remedy this a preplan with v=central supply however, the
quantity was limited.  ED to have insight into how to better implement changes
Series 1
Series 2
         We saw that an overarching unintentional effect we within our department. Unintentional results in this manner
helps create a new culture within the department by
became closer and more supportive which helped create not facilitating a new culture. We can use the techniques here to
better improve our future quality improvement initiatives. 
only a better working environment but also a better learning
environment. Since Covid, overall staff morale has been
low  and forming a togetherness has been difficult. This
proved to be a positive unintentional effect 
Blood Culture Contamination Rates Pre and Post
Utilization of Sterile Techniques References
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Series 1
Series 2
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CDC. (2023). CDC. Retrieved March 28, 2023, from
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1 https://www.cdc.gov/antibiotic-use/core-elements/pdfs/fs-bloodculture-508.pdf
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Category 1 Category 2 Category 3 Category 4
Yahav, D., Shepshelovich, D., & Tau, N. (2021). Cost analysis of new antibiotics to
treat multidrug-resistant bacterial infections: Mind the gap. Infectious Diseases a
   Certain factors also played a critical role within this
Therapy, 10(1), 621–630. https://doi.org/10.1007/s40121-021-00412-y
quality improvement project. The patient acuity level,
limited staffing, high patient volume, and limited supply
days proved to be challenging.    
Conclusion
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      Reducing blood culture contamination rates proved to
have positive effects when implemented with a team
approach putting into account the willingness of the team to
work together.