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초록
Background
Blood culture is essential for the diagnosis and management of bloodstream infections. Blood volume is a key parameter determining the success of blood cultures. Studies comparing compliance between physicians and phlebotomists regarding optimal blood culture procedure are very rare in Korea.
Methods
After educating physicians (interns) and phlebotomists about the correct procedure for blood culturing, the blood volumes of forty-three percent of randomly selected aerobic and anaerobic culture sets for adult patients (≥18 years old) were compared between these two groups over a period of three months. Physicians obtained blood from all admitted patients except those in the emergency department, where phlebotomists performed blood collection
Results
The numbers of blood culture sets requested during the study period were 3,238 and 2,136 for the physician and phlebotomist groups, respectively. The blood volumes of blood culture sets were significantly higher for the phlebotomists (16.7 mL) than for the physicians (9.2 mL). The positive rate of blood culture was also higher for the phlebotomist group (10.3% vs. 7.9%). The contamination rates (0.8%) were the same for both groups.
Conclusion
Although the patients' medical conditions, antibiotics prescriptions, or duration of hospitalization may have affected the positive rate of blood cultures, this rate might also have been influenced by the blood volume. The compliance of phlebotomists was greater than that of physicians regarding the blood volume collected for blood cultures.
REFERENCES
1.Reimer LG., Wilson ML., Weinstein MP. Update on detection of bacteremia and fungemia. Clin Microbiol Rev. 1997. 10:444–65.
2.Weinstein MP., Towns ML., Quartey SM., Mirrett S., Reimer LG., Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997. 24:584–602.
3.Alahmadi YM., Aldeyab MA., McElnay JC., Scott MG., Darwish Elhajji FW., Magee FA, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect. 2011. 77:233–6.
4.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. 47:1021–4.
5.Hall KK., Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev. 2006. 19:788–802.
6.Cockerill FR 3rd., Wilson JW., Vetter EA., Goodman KM., Torgerson CA., Harmsen WS, et al. Optimal testing parameters for blood cultures. Clin Infect Dis. 2004. 38:1724–30.
7.Towns ML., Jarvis WR., Hsueh PR. Guidelines on blood cultures. J Microbiol Immunol Infect. 2010. 43:347–9.
8.Clinical and Laboratory Standards Institutes. Principles and Pro-cedures for Blood Cultures; Approved Guidline. Document M47-A. Wayne, PA; Clinical and Laboratory Standards Institute. 2007.
9.Shin JH., Song SA., Kim MN., Kim S. Nationwide survey of blood culture performance regarding skin disinfection, blood collection and laboratory procedures. Korean J Clin Microbiol. 2011. 14:91–6.
10.Bouza E., Sousa D., Rodríguez-Créixems M., Lechuz JG., Muñoz P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol. 2007. 45:2765–9.
11.Shin JH., Song SA., Kim MN., Lee NY., Kim EC., Kim S, et al. Comprehensive analysis of blood culture performed at nine university hospitals in Korea. Korean J Lab Med. 2011. 31:101–6.
12.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. 122:216–21.
13.Gibb AP., Hill B., Chorel B., Brant R. Reduction in blood culture contamination rate by feedback to phlebotomists. Arch Pathol Lab Med. 1997. 121:503–7.
14.Kang H., Kim SC., Kim S. Comparison of chlorhexidine-alcohol and povidone-iodine for skin antisepsis and the effect of increased blood volume in blood culture. Korean J Clin Microbiol. 2012. 15:37–42.
15.Eskira S., Gilad J., Schlaeffer P., Hyam E., Peled N., Karakis I, et al. Reduction of blood culture contamination rate by an educational intervention. Clin Microbiol Infect. 2006. 12:818–21.
16.Roth A., Wiklund AE., Pålsson AS., Melander EZ., Wullt M., Cronqvist J, et al. Reducing blood culture contamination by a simple informational intervention. J Clin Microbiol. 2010. 48:4552–8.
17.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. 129:1222–5.
18.Surdulescu S., Utamsingh D., Shekar R. Phlebotomy teams reduce blood-culture contamination rate and save money. Clin Perform Qual Health Care. 1998. 6:60–2.
19.Weinbaum FI., Lavie S., Danek M., Sixsmith D., Heinrich GF., Mills SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol. 1997. 35:563–5.
Table 1.
Blood volume of each set of blood culture between physicians and phlebotomists*
| Period | Physicians | Phlebotomists | ||
|---|---|---|---|---|
| N | Volume | N | Volume | |
| November, 2011 | 498 | 11.2 (5.9) | 336 | 15.7 (5.4) |
| December, 2011 | 320 | 8.2 (5.9) | 170 | 15.5 (5.3) |
| January, 2012 | 580 | 7.9 (4.8) | 406 | 16.9 (4.9) |
Table 2.
The blood volumes collected for blood cultures, the positive rate, and the contamination rate for physicians and phlebotomists*
| Physicians | Phlebotomists | P value | |
|---|---|---|---|
| Blood volume (Mean±SD) | 9.2±5.9 mL | 16.7±5.5 mL | ＜0.001 |
| Positive rate | 7.9% | 10.3% | ＜0.001 |
| Contamination rate | 0.8% | 0.8% | 0.878 |
Table 3.
Frequency of isolates of blood culture between physician group (wards) and phlebotomist group (emergency department)
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