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Abstract
Purpose
Blood culture is an essential diagnostic tool and requires clear indications, proper techniques, and quality control. We aimed to investigate whether blood cultures in children are appropriate for indications, are performed correctly, and receive proper quality control.
Methods
We conducted an online survey targeting pediatric infectious diseases (ID) specialists working in general hospitals and neonatologists (Neo) working at hospitals operating a neonatal intensive care unit in Korea.
Results
Approximately 81.1% (30/37) of pediatric ID specialists and 72.2% (52/72) of Neo responded to the survey. Some of the respondents (33.3% of ID and 59.6% of Neo) performed blood culture as a regular test irrespective of the indication. Approximately 40% of ID and 65.4% of Neo ordered only one set of blood culture in patients suspected with bacteremia. The most commonly used disinfectant for skin preparation was povidone-iodine, while the skin preparation method varied by institution. Approximately two-thirds of the institutions were monitoring the blood culture contamination rate, whereas relatively few provided staff with feedback on that rate. In addition, less than half of the institutions were providing regular staff training on blood culture (40% of ID and 28.8% of Neo).
Conclusions
The indication and methods of blood culture for children varied according to institution, and few hospitals exert effort in improving the quality of blood culture. Institutions have to strive constantly toward improvement of blood culture quality and evidence-based recommendations for pediatric blood cultures should be standardized.
References
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Fig. 1.
The job roles of the staff that collect blood from patients were compared among different places of work. (A) Staff who performed blood culture in child patients in the pediatric emergency room (ER), the ward, and in the pediatric intensive care unit (PICU). A total of 30 pediatric infectious disease specialists responded to the survey. (B) Staff who performed blood culture in neonates in the nursery, the neonatal intensive care unit (NICU), and in the ER. A total of 52 neonatologists responded to the survey.
Table 1.
Differences in the Practice of Obtaining Blood Cultures between Children and Neonates
| Variable | Children (n=30)∗ | Neonates (n=52)† | P-value |
|---|---|---|---|
| Obtaining blood cultures as regular blood tests | 10 (33.3) | 31 (59.6) | 0.022 |
| Ordering one set of blood culture in patients with suspected bacteremia | 12 (40.0) | 34 (65.4) | 0.026 |
| Collecting blood from one site puncture for two sets of blood cultures | 18 (60.0) | 25 (48.1) | 0.960 |
| Collecting blood via venipuncture | 30 (100.0) | 33 (63.5) | <0.001 |
∗ Data was collected from pediatric infectious diseases specialists working in general hospitals or teaching hospitals. They responded to the questionnaire, which contain questions about blood culture for children who were based in the emergency room, ward, or the pediatric intensive care unit.
† Data was collected from neonatologists working in neonatal intensive care units in general hospitals or teaching hospitals. They responded to the questionnaire, which co tained questions about blood culture for neonates who were based in the emergency room, nursery, or the neonatal intensive care unit.
Table 2.
Survey Results of Blood Culture Procedure and Quality Control
| Variable | Children (n=30) | Neonates (n=52) |
|---|---|---|
| Blood culture procedure | ||
| Disinfection of the rubber septum on the blood culture bottle | 26 (86.7) | 47 (90.4) |
| Type of disinfectants used on the rubber septum on the blood culture bottle∗ | ||
| Povidone-iodine | 9 (34.6) | 19 (40.4) |
| Alcohol | 8 (30.8) | 12 (25.5) |
| Chlorhexidine | 8 (30.8) | 12 (25.5) |
| Chlorhexidine then alcohol | 0 | 3 (6.4) |
| No. of disinfectants used for skin preparation | ||
| One† | 14 (46.7) | 28 (53.8) |
| Two‡ | 15 (50.0) | 21 (40.4) |
| More than three | 1 (3.3) | 3 (5.8) |
| Provider antisepsis method | ||
| Use of sterile gloves | 13 (43.3) | 28 (53.8) |
| Quality control methods | ||
| Transporting the blood culture bottle directly to the continuous-monitoring blood culture instruments | 20 (66.7) | 36 (69.2) |
| Blood culture contamination monitoring | 18 (60.0) | 38 (73.1) |
| Feedback on contamination rate to the provider | 10 (33.3) | 25 (48.1) |
| Regular education on blood culture procedures | 12 (40.0) | 15 (28.8) |
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