Implementing a quality improvement initiative to reduce blood culture contaminations involves utilizing evidence-based practices within DMAIC framework. This includes assessing structures (e.g., equipment), processes (e.g., collection techniques), and outcomes (e.g., contamination rates). By incorporating best practices, such as staff training on aseptic techniques and a non-additive discard tube, we aimed to enhance the quality of blood culture collection and decrease contamination rates, which led to improved patient outcomes and organization cost savings.
Problem: Elevated blood culture contamination rates negatively impact patient outcomes and drive increased organizational costs. In 2022, medicine services had a combined blood culture contamination rate of 1.4%, estimating cost of $391,937. The Clinical Laboratory Standards Institute (CLSI) states when best practices are followed a rate of <1.0% is achievable.
Measurement: Blood Culture Contaminations are measured by total specimen count divided by contamination count. A contamination is defined by the presence of a common commensal organism in one of 2 blood culture sets. Rates are available through a dashboard which provides data visibility with the use of a run chart.
Analysis: To understand whether the changes we implemented were attributed to our implementation of using ISDT, a Chi-Square Test, at 95% confidence interval, was performed. This analysis resulted in a P-value of 0.001 indicating a statistical significance.
Implementation: We implemented ISDT using a discard tube to remain financially fiscal in lieu of commercial devices. Our literature search identified one significant barrier in this approach to achieving a positive outcome was the cleaning of the non-additive discard tube. We were able to achieve antisepsis using alcohol swab sticks.
Results/Discussion: In 2022, pre-intervention: 20 medical units blood culture contamination rate of 1.4 decreased to 0.8 post implementation of the ISDT with discard. We calculated a statistical significance using a chi-square test of proportions with a 95% confidence interval with a P-value of 0.001. The plan is to adopt systemwide.
