Best Practices

3% only means you’ve hit the board.
Aim for the bullseye below 1%.

In 2005, CAP reported information from hundreds of institutions regarding their rates of contaminated blood cultures. The average contamination rate was found to be approximately 3%.¹

The 3% average was adopted as a performance benchmark in 2007 when the Clinical and Laboratory Standards Institute (CLSI) included the “3% maximum blood culture contamination rate” in their guidelines.²

Today, blood culture contamination rates differ widely between institutions, frequently exceeding 3%.^3,4

At 3% the benchmark misses the mark

Nearly one-third of positive results are wrong.
More than 1 Million patients are placed at risk by a false positive result each year.

Research supports narrowing the target to a blood culture contamination rate below 1%.⁵

Read supporting research

Centers for Medicare and Medicaid Services (CMS) Takes a Stand

Final rule 42 C.F.R § 482.42 to amends the Conditions of Participation:

[That] “…a hospital’s infection prevention and control and antibiotic stewardship programs be active and hospital-wide for the surveillance, prevention, and control of [hospital acquired infections] and other infectious diseases, and for the optimization of antibiotic use through stewardship.”

By Spring 2020, hospitals must “demonstrate adherence to nationally recognized infection prevention and control guidelines for reducing the transmission of infections, as well as best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic-resistant organisms.”

Read the Published Final Rule

A two-part strategy for reducing contamination rates

Guideline Compliance Application of Technology

Clinical Guidelines

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

Technology to address skin contaminants.

“It is currently accepted that most organisms identified as contaminants in BCs originate from the skin of the patient.”
– AJIC, 2015⁶
Skin contaminants are the most common blood culture contamination source. Roughly 20% of the microbes present in skin reside deep in the dermis layer unaffected by skin antisepsis.⁶

When a venipuncture is made, the needle cores out a minute section of the patient’s skin. This skin plug may contain microbes that can flow into the culture bottle.

Using a technique that sets aside the blood and skin contaminants within the initial flash during routine blood culture collection, can reduce skin contaminants in the culture bottle, which contribute to false positive results. When paired with best practice implementation, this flash technology has been shown to be effective.

There are three methods of preventing contaminants from entering the blood culture bottle which vary in complexity and user requirements: a waste tube, a mechanical device, and a passive device. Click to review study data.

Considerations for choosing Contamination Reduction Technology

The technology should waste a minimal amount of blood, since blood is valuable, and blood cultures are often repeated.
To increase compliance, the process of preventing the initial blood from entering the culture bottle needs to be simple. A product that closely matches current practice will reduce the need for training and contribute to long-term compliance. A passive device will yield higher compliance than a device that requires a change in technique. Assuming a high rate of compliance, a hospital starting with 20 contaminations per month can expect to save hundreds of thousands of dollars per year.
Waste optimization and disposal costs vary by method. Selecting a compact technology that uses minimal packaging lowers disposal costs and improves storage, which further supports high compliance.
To accurately assess the technology when reporting data, the results should reflect ALL contaminations, not just those which occur when the technology is used. This broader metric demonstrates the ease of clinician compliance and reflects the product’s practical efficacy within your facility.

Contamination Reduction Technologies

PASSIVE

Passive
The blood culture set includes integrated, passive flash technology with a u-shaped channel that sidelines skin microbes within the initial flash, without user manipulation.

Learn more at kurin.com

MECHANICAL

Discard Vial
A diversion tube is used to collect and waste the initial volume of blood.

User-Controlled
A manual mechanism is required to prevent the initial volume from reaching the blood culture bottle.

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 Doern GV, Carroll KC, Diekema DJ, Garey KW, Rupp ME, Weinstein MP, Sexton DJ. A Comprehensive Update on the Problem of Blood Culture Contamination and a Discussion of Methods for Addressing the Problem. Clin Microbiol Rev. 2019 Oct 30;33(1).
6 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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BEST PRACTICES

3% only means you’ve hit the board. Aim for the bullseye below 1%.