Activities of Quality Improvement for Blood Culture at a University Hospital

Hae In Bang; Hyun Mi Lim; Eui Young Jang; Eun Su Park; Eun Jung Lee; Tae Hyong Kim; Rojin Park; Jeong Won Shin; Tae Youn Choi

doi:10.5145/ACM.2015.18.3.88

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Bang, Lim, Jang, Park, Lee, Kim, Park, Shin, and Choi: Activities of Quality Improvement for Blood Culture at a University Hospital

Original Article

Ann Clin Microbiol 2015;18(3):88-93.

Published online: 5 September 2015

DOI: https://doi.org/10.5145/ACM.2015.18.3.88

Activities of Quality Improvement for Blood Culture at a University Hospital

Hae In Bang¹, Hyun Mi Lim¹, Eui Young Jang¹, Eun Su Park¹, Eun Jung Lee², Tae Hyong Kim², Rojin Park¹, Jeong Won Shin¹, Tae Youn Choi¹

¹Department of Laboratory Medicine, Soonchunhyang University Hospital, Seoul, Korea

²Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea

Correspondence: Tae Youn Choi, Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, 59 Daesaqwan-ro, Yongsan-gu, Seoul 04401, Korea. (Tel) 82-2-709-9425, (Fax) 82-2-790-5820, (E-mail) choity@schmc.ac.kr

Received 18 May 201528 August 2015 Accepted 2 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

Blood culture is a critical test for diag-nosing bloodstream infections. Frequent microbial contamination during sampling and testing leads to abuse of antimicrobial agents. We evaluated methods for reducing contamination and obtaining more reliable results.

Methods

We analyzed blood cultures obtained between 2009 and 2015. We established 6 quality indicators: true positive rate, contamination rate, blood sampling volume, number of sets of blood cultures, delayed transportation rate, and percentage of samples collected from the femoral region, with reference to the CLSI guideline M47-A, 2007. Education was provided for interns and nurses responsible for blood sampling and transportation of specimens, and data were analyzed monthly.

Results

At baseline, the true positive rate was 12.8%, and the contamination rate was 4.0%. During the in-tervention period, these were decreased to 10.9% and 1.9%, respectively. The percentage of samples smaller than 5 mL decreased from 29.7% to 2.7- 11.3%. The rate of one set of blood cultures being ordered was always ＜5%. The delayed transportation rate decreased from 35.6% to 5.5-7.7%. Finally, the percentage of samples collected from the femoral region decreased from 41.5% to 22.0-31.0%, be-cause of which we did not attain our goal, 20.8%.

Conclusion

The results showed improvements in contamination rate, specimen volume, specimen transportation time, and the percentage of samples collected from the femoral region. The quality management of blood cultures in 2011 was comparatively poor, which led to increased contamination rate, large number of samples containing ＜5 mL of blood, and increased percentage of samples collected from the femoral region. Thus, quality improvement methods can produce more reliable results of blood cultures.

Keywords: Blood culture, Contamination, Femoral artery, Femoral vein, Quality improvement

REFERENCES

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Fig. 1.

Blood collection guidelines for culture used in this study.

Table 1.

The total blood positivity and contamination from March 2009 to February 2015

Year	No. of positive specimens (%)	No. of contaminations (%)
2009	1,829 (12.8)	581 (4.0)
2010	1,208 (10.1)	276 (2.3)
2011	1,505 (12.5)	328 (2.7)
2012	1,397 (11.8)	267 (2.2)
2013	1,420 (10.0)	208 (1.5)
2014	1,433 (9.1)	191 (1.2)

Table 2.

Contamination rate according to the blood collection site from July to September 2014

Index	Upper limb	Femoral region	Lower limb	Catheter*	Others†
No. of specimens	2,120	1,000	240	362	102
No. of contaminations (%)	15 (0.7)	17 (1.7)	2 (0.8%)	1 (0.3)	1 (1.0)

^∗ 321 central venous catherters and 41 arterial catherters;

^† Others include head and neck regions and not informed cases.

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