Centers for Medicare and Medicaid Services (CMS) Takes a Stand
A two-part strategy for reducing contamination rates
Emergency Nurses Association (ENA).
ENA Emergency Nursing Resources Development Committee. Clinical practice guideline: prevention of blood culture contamination. Emergency Nurses Association; 2012 Dec.
Recommendation 13. Divert the initial 1–2 ml of blood into a sterile receptacle when drawing blood culture specimens via peripheral venipuncture. Level B – Moderate (Patton & Schmitt, 2010) (Note: New evidence is pending. When it is available, this recommendation will be updated if indicated.)
College of American Pathologists (CAP)
CAP 2018 Q-Tracks: MIC.22630
“It is recommended that blood culture statistics, including number of contaminated cultures, be maintained and reviewed regularly by the laboratory director. The laboratory should establish a threshold for an acceptable rate of contamination. Tracking the contamination rate and providing feedback to phlebotomists or other persons drawing cultures has been shown to reduce contamination rates.”
American Society for Microbiology
Amy L. Leber. 2016. Blood Cultures, p 151-182. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch3.4
Clinical and Laboratory Standards Institute (CLSI®)
Wilson, ML. CLSI: Principles and Procedures for Blood Cultures; Approved Guideline, Issue 17.
CLSI document M47-A (ISBN 1-56238-641-7). 2007.
CDC Clinician Guide for Collecting Cultures.
E. Septimus. Clinician Guide for Collecting Cultures 2015
Initial Specimen Discard Methods
Consideration for choosing an initial specimen discard method
Initial Specimen Discard Technologies
1 Bekeris LG, Tworek JA, Walsh MK, Valenstein PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med. 2005 Oct;129(10):1222-5.
2 Clinical and laboratory Standards Institute (CLSI). Principles and procedures for blood cultures: approved guideline. CLSI document M47-A. Wayne (PA): Clinical and Laboratory Standards Institute; 2007.
3 Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 2009 Apr;47(4):1021-1024.
4 Schifman RB, Strand CL, Meier FA, Howanitz PJ. Blood culture contamination: A College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 1998 Mar;122(3):216-221.
5 Garcia RA, Spitzer ED, Beaudry J, et al. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremia, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control. 2015 Nov 1;43(11):1222-37.
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