Effects of Blood Volume Monitoring on the Rate of Positive Blood Cultures from the Emergency Room
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Background: Blood cultures are essential in diagnosing and treating sepsis. There are several factors that affect the diagnostic yield of blood cultures such as the number of blood sampling episodes, the incubation period, the type and volume of culture media, and the amount of blood drawn. This study aimed to elucidate whether monitoring the volume of blood drawn with an educational intervention could affect the diagnostic quality of blood cultures. Methods: We implemented quality monitoring for the blood volume drawn during blood culture testing for adults in an emergency room. We instructed the nurses in the emergency room to draw the optimal amount of blood and to reduce the number of blood culture sets from three to two. We analyzed and compared the amount of blood drawn, the rate of positive blood cultures, the contamination rate, and time to positivity (TTP) between 908 patients pre-intervention and 921 patients post-intervention. Results: The amount of blood drawn increased from 0.7±0.3 mL per bottle (pre-intervention) to 6.5±1.7 mL per bottle (post-intervention) (P＜0.0001). The rate of positive blood culture post-intervention (12.14%) was higher than that pre-intervention (6.65%) (P＜0.0001). The contamination rate post-intervention (1.82%) was also significantly greater than that pre-intervention (0.60%) (P＜0.0001). Except for anaerobes, there was no significant difference in the distribution of microorganisms between the pre- and post-intervention periods. The TTP for anaerobe bottles post-intervention was significantly shorter than that of pre-intervention (16.1±16.3 versus 18.6±18.3 h). Conclusion: This study suggests that continuing education about adequate blood volume and aseptic techniques is needed to increase the rate of positive blood cultures and reduce the contamination rate of blood cultures.
Abstract
Background: Blood cultures are essential in diagnosing and treating sepsis. There are several factors that affect the diagnostic yield of blood cultures such as the number of blood sampling episodes, the incubation period, the type and volume of culture media, and the amount of blood drawn. This study aimed to elucidate whether monitoring the volume of blood drawn with an educational intervention could affect the diagnostic quality of blood cultures. Methods: We implemented quality monitoring for the blood volume drawn during blood culture testing for adults in an emergency room. We instructed the nurses in the emergency room to draw the optimal amount of blood and to reduce the number of blood culture sets from three to two. We analyzed and compared the amount of blood drawn, the rate of positive blood cultures, the contamination rate, and time to positivity (TTP) between 908 patients pre-intervention and 921 patients post-intervention. Results: The amount of blood drawn increased from 0.7±0.3 mL per bottle (pre-intervention) to 6.5±1.7 mL per bottle (post-intervention) (P＜0.0001). The rate of positive blood culture post-intervention (12.14%) was higher than that pre-intervention (6.65%) (P＜0.0001). The contamination rate post-intervention (1.82%) was also significantly greater than that pre-intervention (0.60%) (P＜0.0001). Except for anaerobes, there was no significant difference in the distribution of microorganisms between the pre- and post-intervention periods. The TTP for anaerobe bottles post-intervention was significantly shorter than that of pre-intervention (16.1±16.3 versus 18.6±18.3 h). Conclusion: This study suggests that continuing education about adequate blood volume and aseptic techniques is needed to increase the rate of positive blood cultures and reduce the contamination rate of blood cultures.
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