Reduction of Contaminated Blood Cultures Connie Clark Vice President of Nursing Services Pat Sather Hartell Microbiology Supervisor Jennifer LeClercq Emergency Department Manager Cathy Paulus Infection Control Coordinator Jean Wojtanek Lab Manager Emergency Department Nursing Staff Nursing Council Leadership Group Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Aim Statement Goal: To reduce blood culture contaminants to 3% or below *Potential Consequences of Contaminated Blood Cultures: Exposure to antibiotics can lead to acquisition of multidrug resistant organisms Additional diagnostic testing Prolonged hospital stay or unnecessary admission Increased costs and utilization of resources Decreases the positive predictive value of the blood culture system *Clinical Laboratories Standards Institute/College of American Pathologists Confidential - Quality Improvement Materials

Multidisciplinary Team Plan Form a multidisciplinary team to reduce blood culture contaminants Review historical data related to blood culture results Review literature for “best practices” in obtaining blood cultures Create a blood culture competency to address staff knowledge deficit related to blood culture collection Direct efforts to decrease contamination rate for ED specimens Target staff collecting blood cultures: Phlebotomists and Emergency Department staff Explore clinical lab blood culture systems Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Actions Implemented Required ED nursing staff to complete Blood Culture competency at hire and quarterly Required return demonstration of specimen collection including itemized steps on competency Educated staff on basic knowledge regarding skin antisepsis, central line catheter biofilm, and consequences of contaminated blood culture results Developed department trainers to educate staff Implemented Versatrek blood culture collection system Performed analysis of potential costs attributed to contaminated specimens Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Ongoing Actions Monitor blood culture contaminant results monthly Communicate contaminant results to department manager Share department results with staff monthly Provide direct feedback of individual performance Re-educate staff as needed Share results with key stakeholders Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Goal ≤ 3% Confidential - Quality Improvement Materials

Individual Counseling and competency of ED personnel Versatrek Blood Culture System Implemented house-wide Goal 3% Analysis: Since individual counseling and education of ED staff in Q1 2007, the rate of blood culture contamination has decreased consistently. Further improvement noted after implementation of new blood culture system house-wide. The ED achieved rates below the benchmark goal of 3% in the last two quarters. Overall mean average is at 4.62.

Goal 3% Versatrek Blood Culture System Implemented house-wide Analysis: The Phlebotomy department consistently performs below the benchmarking goal of 3%. Further improvement noted after implementation of new blood culture system house-wide. Overall mean average is maintained at 1.76.

Cost of a Contaminated Blood Culture Estimated Cost per Contaminant= $4500.00** Estimate Cost Avoidance Associated with the Reduction Contaminated Blood Culture Rate 5 fewer contaminants per quarter would yield potential cost savings of $90,000 annually ** Reference: College of American Pathologists, 2000 Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Analysis Emergency Department achieved 2.7% contamination rate 3rd quarter calendar year 2008 Achieved 2.6% overall contamination rate 4th quarter calendar year 2008 Preliminary 1St quarter calendar year 2009 data: overall contamination rate 2.8% Sustained improvement achieved in 2008 with implementation of Versatrek blood culture collection system and quarterly blood culture competency training Confidential - Quality Improvement Materials

Confidential - Quality Improvement Materials Next Steps Intervene with education and analysis of any upward trending Continue ED staff requirement to complete quarterly competency Ongoing review of literature for best practices related to skin antisepsis, specimen collection, and care and maintenance of a central line Maintain collaborative team and continue reporting to key stakeholders Sustain blood culture contamination rate at or below 2% (revised national benchmark) Confidential - Quality Improvement Materials