Development of Blood Culture and Quality Improvement

Sunjoo Kim

doi:10.5145/ACM.2013.16.4.153

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Kim: Development of Blood Culture and Quality Improvement

Original Article

Ann Clin Microbiol 2013;16(4):153-161.

Published online: 5 December 2013

DOI: https://doi.org/10.5145/ACM.2013.16.4.153

Development of Blood Culture and Quality Improvement

Sunjoo Kim

Department of Laboratory Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea

Correspondence: Sunjoo Kim, Department of Laboratory Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea. (Tel) 82-55-750-8239, (Fax) 82-55-762-2696, (E-mail) sjkim8239@hanmail.net

Received 22 July 201322 August 2013 Accepted 22 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Sepsis is a common and critical illness diagnosed via blood culture. Although a continuous blood culture monitoring system was introduced several deca-des ago, optimal utilization and improvement of blood culture methods has not been discussed recently. The author describes several blood culture-related topics including optimal blood collection procedures, quality control indicators, prior antibiotic treatment, delayed entry, time to detection, follow-up blood culture, catheter-related bloodstream infection, and new techniques to rapidly identify microorganisms. Although rapid, automatic blood culture systems are likely to be developed in the near future, quality improvement should be accomplished by well-educated medical personnel.

Keywords: Blood, Catheter-related infections, Culture, Quality control, Quality improvement

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Table 1.

Indicators and suggestions for the improvement of quality in blood cultures

No.	Indicators	Suggestions
1	No. of requests	Adults should be requested at least twice per event to detect more organisms. There is no guideline about the number of requests for children.
2	Blood volume	The amount of blood is the most important parameter and should be 20 mL per each venipuncture. Positive rate should be 6-12%. If it is too low, blood volume should be monitored.
3	Skin disinfection	Alcohol should be scrubbed first. Povidone-iodine should be dried out to kill the normal flora of skin surface. Chlorohexidine or tincture of iodine may be more effective. Bottle caps should be disinfected with alcohol rather than with povidone-iodine. Skin contamination rates should be less than 3%.
4	Anaerobic bottle	Blood should be inoculated into an aerobic bottle first, because it may detect more organisms. Many facultative anaerobic organisms grow only in the anaerobic bottle, suggesting it should not be omitted.
5	Delayed entry	Once blood is injected to the bottles, they should be inserted to the machine within 2 h. If entry is delayed, they could be stored at 37 ^o C to enhance the grwoth of organisms. However, false negative of lactose non-fermenters was reported with this prestorage condition.
6	TTD (time to detection)	TTD of the blood culture system could be monitored. About 70-80% should grow within a day.
7	Pediatric sepsis	Anaerobic bottle may be omitted. Blood volume should not exceed 1% of blood volume; optimal range would be 1-2 mL.
8	Catheter-related bloodstream infection (CRBSI)	Two-hour difference of TTD between peripheral blood and catheter blood could be used to sus-pect CRBSI.
9	Prior antibiotic usage	Prior antibiotic usage is quite common in the admitted patients. Charcoal- or resin-based media could adsorb these antibiotics in the bottle.
10	Follow-up culture	Although the benefit of a follow-up culture within a short period is not proved, many clinicians repeatedly order blood culture. The beneficial effect of follow-up blood culture should be care-fully considered.
11	False positive	Leukocytosis is the main reason of false positive, if the automatic system functions well.
12	False negative	Delayed entry is the main reason of false negative, if the automatic system functions well. Final blind subculture to rule out false negative is not needed, when automatic blood culture system is used.
13	CQI education	Education of medical personnel concerning these issues will improve the quality of blood culture.
14	CVR (critical value report)	Early reports of Gram staining could save the septic patients. It should be reported within 1 h of flag in the instrument.

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