Fellow Phoenix Children's Hospital Phoenix, Arizona, United States
Background: Contaminated blood cultures are a costly issue affecting the healthcare of our patients. Skin bacteria causing false-positive blood cultures increases unnecessary blood draws, antibiotics, hospital admissions and overall hospital costs. The technique in which the culture is drawn along with amount of blood and accurate storage of culture all affect the accuracy of culture. Additionally, many blood cultures may not be clinically indicated. Objective: The aim of this project is to decrease peripheral line blood contamination rates in our Pediatric Emergency Department (PED) from 3.1% in 2022 to 2.0% over the course of a year by implementing multiple PDSA cycles. Design/Methods: The first intervention involved nursing education for new hires on sterile technique from October-December 2022. The second cycle, from February-May 2023, involved an audit tool to be used after blood culture draws within the PED to allow us to see if there is a consistent step where sterility is broken so we can focus education on those areas. The third intervention, from July-current, is an educational series for PED providers and rotating residents on indications for ordering blood cultures The fourth intervention, planned for October 2023, will be to ensure that adequate weight-based volumes of blood are obtained when drawing blood cultures to increase our sensitivity for true bacteremia. By decreasing the number of contaminated blood cultures, we will decrease length of stay, decrease the number of patients called back to the PED, and decrease total days on antibiotics. Our outcome measures will be total numbers of contaminated blood and number of blood cultures obtained. Our process measure will estimate the savings in charges between the observed and expected contaminants, and the decrease of total cost to laboratory with decreased blood cultures ordered. This multi-faceted approach will not only reduce overall hospital costs but reduce patient harm. The PED is serving as a trial for potential institutional changes within the entire hospital.
