1. BLOOD CULTURE COLLECTION INSTRUCTION ON HOW TO ACCURATELY AND EFFECTIVELY COLLECT A BLOOD CULTURE SPECIMEN

2. THE RATIONALE FOR BLOOD CULTURE COLLECTION Blood cultures aid in the identification of organisms causing a bacterial or fungal bloodstream infection. When combined with antibiotic sensitivity tests they can provide information to physicians concerning antimicrobial therapy. After treatment, cultures are useful in assessing the effectiveness of the antibiotic therapy.

3. BLOOD CULTURE COLLECTION POLICY 1. The policy is LAB 0028. 2. The policy can be found on the McLendon Clinical Labs website under Lab policies. 3. The Routine blood culture set is recommended for the majority of adults with suspected sepsis. 4. Routine blood cultures will recover aerobic and anaerobic bacteria and routine fungal isolates. Each routine blood culture in individuals greater than 20 kg should include 1 BACTEC PLUS aerobic bottle and 1 BACTEC Lytic anaerobic bottle 5. The BACTEC PLUS aerobic bottle is used for pediatric patients weighing less than 20kg.

4. Blood Culture Collection Policy 7. Rare pathogen cultures are reserved for patients with suspected infections with unusual organisms such as Brucella, Bartonella, Hisoplasma, Fransicella, or Norcardia. 8. AFB blood Cultures are reserved for immuno-compromised patients with CD4 counts of <100. Designed to recover Mycobacterium avium Complex or MAC. 9. The number of blood cultures permitted within a specified time is strictly controlled. Refer to policy in the McLendon Clinical Labs website for details.

5. What About a Contaminated Culture?????? 1. Skin preparation of the venipuncture site is an important factor in reducing the rate of blood culture contamination. 2. False positive results may be caused by contamination of the culture with the patient’s skin flora introduced into the blood specimen during collection. 3. Can lead to unnecessary antibiotic therapy. 4. Additional Laboratory testing!!!! 5. More frequent consultations.

6. 6. Increased length of hospitalization and higher costs. $4500…… 7. It has been estimated that each blood culture contaminant is associated with excess costs of approximately $4500…… What About a Contaminated Culture??????

7. CONTAMINATION RATE FOR PHLEBOTOMY SERVICES RATE WAS GREATER THAN 2% A FEW YEARS AGO. WITH MONITORING AND WORKING WITH THE STAFF ON A MONTHLY BASIS THE DEPARTMENT WAS ABLE TO GET OUR RATE DOWN AS LOW AS O.5 %. WITH BETTER DATA COLLECTION OUR CURRENT RATE IS 1.3%. THIS INCLUDES OUR OUTPATIENT PERSONNEL ALSO. UNC HEALTHCARE PHLEBOTOMY SERVICES RATE IS BELOW THE NATIONAL AVERAGE OF 2%. A GREAT ACCOMPLISHMENT.

8. What type of cultures are ordered?

9. What about volume in the bottles? The volume of blood withdrawn is the single most important variable in detecting microorganisms…… The recommended volume to draw from a single venipuncture differs for children and adults. Not safe to obtain large volumes of blood from young children.

10. What about volume in the bottles? BACTEC Plus Aerobic and BACTEC Lytic Anaerobic bottles require 8-10 mls per bottle. (ADULTS) For pediatric patients, the requirements are as follows: <20kg(Infants &children)- 1-4 mls. Up to 4 mls into one BACTEC Plus Aerobic Bottle. 20-40 kg(Children) - 4-8 mls. > 4 mls, divide evenly into 1 BACTEC Plus Aerobic Bottle and 1 BACTEC Lytic anaerobic bottle. Label the pair as one site.

11. Volumes Continue

12. Prepare the bottles! Prepare the bottles by first marking the BACTEC bottles at the desired fill level. Check the fluid and mark 10 mls above that mark with a marker or pen. Remove the flip-off caps on the bottles just before drawing sample. Wipe tops of vials with a single alcohol sponge and allow to dry.

13. Skin site Preparation 1. Cleanse the venipuncture site with 70% isopropyl alcohol. 2. Using ChloraPrep applicator use a gentle back and forth motion for at least 30 seconds. Progress from the insertion site to the periphery. 3. Let the site dry for approximately 30 seconds. The more the better. 4. If site is moist, use a gentle back and forth motion for 2 minutes. Allow the site to dry for approximately 1 minute. 5. Do not bloat or wipe away. 6. Solution should be dry for optimal performance.

15. PATIENTS UNDER THREE MONTHS CLEANSE THE VENIPUNCTURE SITE USING THE PRE-PACKAGED BLOOD CULTURE PREP KIT II CONTAINING AN ALCOHOL FREPP AND A SEPP CONTAINING IODINE…..

16. For Patients Less than 3 Months 1. Remove the Frepp(70% scrub) from the sterile package. 2. Pinch the pad to break the ampule releasing the isopropyl alcohol. 3. Dab the scrub on the arm until the pad is wet. 4. Scrub vigorously with the Frepp for 60 seconds. 5. Allow alcohol to dry. 6. Holding the Sepp prep in a downward position, pinch the center of the Sepp to crush the ampule. 7. Apply iodine tincture to the site starting at the center and moving outward in concentric circles to the periphery. 8. Allow the iodine to dry.

17. Collect the same all the time!! Follow the same procedure all the time. Consistency is most important.

18. References: Garza, Diane & Becan-McBride, Kathleen. (2010). Blood Collection Essentials. Phlebotomy Handbook. (8 th ed.). Schifman, R.B., Strand,CL, NCCLS. Procedures for Collection of Diagnostic Blood Specimens by Venipuncture. Approved Guidelines (H3-A4). (5 th ed.). Vol 18, No 7, June 1998. Meier, F.A., & Howanitz, PJ. (1998). Blood Culture Contamination-A College of American Pathologist Q-Probes Study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med. 122:216-221 Trautner, B.W., Clarridge, J.E., Darouiche, R.O. Skin antisepsis kits containing alcohol and chlorhexidine gluconate or tincture of Iodine are associated with low rates of blood culture contamination. Infection Control and Hospital Epidemiology. 2002. 23: 397-401 Dunne, W.M., F.S, & Wilson, M.L. (1997). Cumitech 1B, Blood Cultures III, April 1997. Baron, et al. 2005 Blood cultures IV, Cumitech 1B ASM Press, American Society of Microbiology, Washington, D.C. Pien, et. Al. 2010 The Clinical and Prognostic Importance of Positive Blood Cultures in Adults. The American Journal of Medicine. Vol 123, No 9, Sept 2010. 819-828 Gilligan P.H. 2012 Blood culture contamination: A clinical and financial burden. Infect. Control Hosp. Epidemiol 34:22-3.