2차 의료기관에서 혈액배양 지표 향상을 위한 채혈자 교육 효과
Educational Intervention to Improve Blood Culture Indicators in a Secondary-Care Hospital
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배경: 혈액배양은 패혈증을 진단하는데 필수적인 검사이다. 혈액배양 시 충분한 양의 혈액 채취가 중요하며, 질 향상을 위해서는 주기적으로 채혈량 모니터링과 피드백이 필요하다. 방법: 2차 의료기관에서 혈액배양 시 고려해야 할 점에 대해서 채혈전담자를 대상으로 교육을 시행하였다. 2018년 11월부터 2019년 6월까지 교육 전 4개월과 교육 후 4개월 두 기간으로 나누어혈액배양의 채혈량, 양성률, 피부 상재균 오염률 및 균 검출시간을 비교하였다. 결과: 채혈량은 평균 5.4 mL에서 7.3 mL로 35.2% 증가하였고(P < 0.0001), 적합한 채혈량(8-12 mL) 비율은 9.1%에서 39.4%로 약 4배 증가하였다(P < 0.0001). 양성률은 기대와는 달리 7.9%에서 6.1% 로 오히려 감소하였으며, 피부 오염률은 0.5%에서 1.1%로 증가하였다. 균 검출시간은 14.9시간에서 13.1시간으로 감소하였다(P = 0.0478). 결론: 채혈전담자 교육 후 채혈량 및 균 검출시간은 향상되었지만 혈액배양 양성률은 증가하지않았다. 따라서 2차 의료기관에서 혈액배양 양성률은 채혈량 이외에도 환자의 중증도에 의해 큰영향을 받는 것을 추론할 수 있다.
Abstract
Background: Blood culture is essential for diagnosis of sepsis. However, usually the available blood volume is not sufficient to meet the guidelines. Thus, periodic monitoring and feedback are essential to improve the quality of blood cultures. Methods: We analyzed blood cultures requested between November 2018 and June 2019, and provided educational intervention and coaching for phlebotomists at the end of February 2019. Then, we evaluated the impact of education on blood cultures in a secondary‑care hospital. Blood volume, positive rate, contamination rate, and time to detection (TTD) were compared between the pre- (November 2018 to February, 2019) and post-intervention periods (March to June, 2019). Results: The average blood volume increased significantly from 5.4 mL to 7.1 mL (P < 0.0001) (35.2%) after intervention. Accordingly, the proportion of optimal blood volume (8–12 mL) increased from 9.1% to 37.8% (P < 0.0001). Before the intervention, the positivity rate was 9.6% and the contamination rate was 0.5%, whereas after the intervention, the positivity rate decreased to 9.1% and the contamination rate increased to 1.1%. TTD improved from 14.7 hours to 13.1 hours (P = 0.0420). Conclusion: The educational intervention of the phlebotomy team improved the quality of blood cultures, especially blood volumes and TTD. However, the positivity rate did not increase, suggesting that it is affected not only by the blood volumes but also by the severity of the underlying illnesses of the patient in a secondary-care hospital.
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