Based on current evidence, most healthcare professionals, physicians, and microbiologists consider blood culture as one of the most essential parameters in laboratory assessment, especially in the emergency department (ED) (Patton, 2016). It is important for nursing professionals in the ED to identify, assess, implement, and evaluate effective strategies to prevent and control blood culture contaminations (Bentley, et al. 2016). As per recent guidelines and recommendations, nurses involved in the ED can follow the PICO format for the prevention and control of blood culture contamination (Snyder, et al. 2012).
Population (P): Patients admitted in the emergency care department. Most patients are subject to initial screening and blood culture assessments in the ED in order to provide a comprehensive and high quality care service. Intervention (I): In order to prevent contamination of the blood culture, nursing professionals can include skin antiseptics in skin preparation such as Chlorhexidine + alcohol or Sequential isopropanol + iodine tincture (iodine + alcohol). The other interventions may include the use of sterile gloves while handling the patient along with a clean or sterile bottle top for collection of blood culture. The inclusion of prepared and pre-packaged kits for blood collection samples is recommended by the Centres for Disease Control (CDC) and is known to reduce the rate of blood culture contamination. Effective education and training of staff involved in blood culture collection is also an effective strategy to reduce contamination (Bowen, et al. 2106). Comparison (C): The intervention was compared to conventional methods of blood culture collection such as the use of non-sterile gloves, lack of education and training of personnel, limited skin preparation techniques, and limited availability of pre-packaged kits (Chang, et al. 2015). Outcomes (O): The estimated outcomes is the significant reduction in the rate of blood culture contamination in the ED owing to evidence-based practice methods such as skin preparation, sterility, education/training, and the inclusion of sterile and pre-packaged kits for effective and feasible means of blood collection. It is also associated with low rate of infections and re-assessment (Self, et al. 2014).
References
Bentley, J., Thakore, S., Muir, L., Baird, A., & Lee, J. (2016). A change of culture: reducing blood culture contamination rates in an Emergency Department. BMJ Quality Improvement Reports, 5(1), u206760.w2754.
Bowen CM, Coleman T, Cunningham D (2016). Reducing Blood Culture Contaminations in the Emergency Department: It Takes a Team. J Emerg Nurs. 42(4):306-11.
Chang, C.-J., Wu, C.-J., Hsu, H.-C., Wu, C.-H., Shih, F.-Y., Wang, S.-W., Shih, H.-I. (2015). Factors Associated with Blood Culture Contamination in the Emergency Department: Critical Illness, End-Stage Renal Disease, and Old Age. PLoS ONE, 10(10), e0137653.
Patton RG (2016). Blood Culture Contamination Definitions Can Obscure the Extent of Blood Culture Contamination: A New Standard for Satisfactory Institution Performance Is Needed. Infect Control Hosp Epidemiol. 37(6):736-8.
Self, W. H., Mickanin, J., Grijalva, C. G., Grant, F. H., Henderson, M. C., Corley, G., Paul, B. R. (2014). Reducing Blood Culture Contamination in Community Hospital Emergency Departments: Multicenter Evaluation of a Quality Improvement Intervention. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 21(3), 274–282.
Snyder, S. R., Favoretto, A. M., Baetz, R. A., Derzon, J. H., Madison, B. M., Mass, D., Liebow, E. B. (2012). Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis. Clinical Biochemistry, 45(0), 999–1011.
