1. 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

2. 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

3. 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

4. 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

5. 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

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

7. 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.

8. 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.

9. Cost of a Contaminated Blood Culture
Estimated Cost per Contaminant= $ **
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

10. 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

11. 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