Journal of Hospital Infection 88 (2014) 120e122 Available online at www.sciencedirect.com
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Letters to the Editor
Response to Dawson S, ‘Blood culture contaminants’, J Hosp Infect 2014, vol. 87, pp. 1e10 Madam, We read with interest the article by Dr Susan Dawson on blood culture contamination rates.1 In our hospital, blood culture packs were introduced in 2007, along with a hospital-wide awareness campaign and restriction of staff taking cultures to those with certified competencies. This resulted in a reduction of the blood culture contamination rate from 45% to 23% of total positive cultures.2 We have monitored our contamination rates since then, moving to the Q-Probes definition.3 Our contamination rates have shown a sustained reduction and are currently around the 3% threshold. The yearly rates for the last three years have been 2.7%, 3.4%, and 3.3%. Whereas using the set definition makes it much simpler to calculate contamination rate, it does overestimate by w0.4%.3 This would suggest that our rates remain broadly acceptable. It can be seen from our local statistics that we are struggling to reduce rates further. At this stage, the other aspects raised become important, such as interdepartmental differences. Therefore, we plan to give unit-specific feedback on contamination rates. Our ward contamination rates are 2.3% and in these areas we have dedicated phlebotomy teams in-hours who take the cultures. However, our accident and emergency (A&E) department has been particularly problematic, with contamination rates consistently exceeding 3%. From Dawson’s review and other literature searches, it is clear that this is a universal problem and due to a large number of factors. To address this issue, we are planning a retraining programme of A&E staff as well as internal peer-review of blood-culturetaking techniques with colleagues and role models or ‘clinical champions’. However, we are concerned that feedback on contamination rates has the potential to negatively impact the confidence of staff in taking cultures and therefore may result in a reduction in numbers of cultures taken, as found by Thomas et al.4 In response to this concern, our feedback sessions will incorporate significant contribution from role models from within the clinical area concerned, to minimize risk of perceived external criticism, and to improve local ownership of the issue. Data will be collected to give
assurance that blood cultures continue to be collected in all appropriate clinical scenarios. We will re-audit contamination rates again next year and hope to see an improvement in the A&E data and a sustained low value in the inpatient rates. Conflicts of interest None declared. Funding sources None.
References 1. Dawson S. Blood culture contaminants. J Hosp Infect 2014;87:1e10. 2. Bamber AI, Cunniffe JG, Nayar D, Ganguly R, Falconer E. Effectiveness of introducing blood culture collection packs to reduce contamination rates. Br J Biomed Sci 2009;66:6e9. 3. 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. Archs Pathol Lab Med 1998;122:216e221. 4. Thomas S, Cheesborough J, Plumb S, et al. Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences. J Hosp Infect 2011;78:256e259.
M. Shakeshaft* J. Cunniffe D. Harvey Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK * Corresponding author. Address: Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral, Merseyside CH49 5PE, UK. Tel.: þ44 (0) 151 678 5111; fax: þ44 (0) 151 604 0370. E-mail address: [email protected] (M. Shakeshaft). Available online 30 July 2014 http://dx.doi.org/10.1016/j.jhin.2014.07.007 Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved.
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Letters to the Editor
Response to Dawson S, ‘Blood culture contaminants’, J Hosp Infect 2014, vol. 87, pp. 1e10 Madam, We read with interest the article by Dr Susan Dawson on blood culture contamination rates.1 In our hospital, blood culture packs were introduced in 2007, along with a hospital-wide awareness campaign and restriction of staff taking cultures to those with certified competencies. This resulted in a reduction of the blood culture contamination rate from 45% to 23% of total positive cultures.2 We have monitored our contamination rates since then, moving to the Q-Probes definition.3 Our contamination rates have shown a sustained reduction and are currently around the 3% threshold. The yearly rates for the last three years have been 2.7%, 3.4%, and 3.3%. Whereas using the set definition makes it much simpler to calculate contamination rate, it does overestimate by w0.4%.3 This would suggest that our rates remain broadly acceptable. It can be seen from our local statistics that we are struggling to reduce rates further. At this stage, the other aspects raised become important, such as interdepartmental differences. Therefore, we plan to give unit-specific feedback on contamination rates. Our ward contamination rates are 2.3% and in these areas we have dedicated phlebotomy teams in-hours who take the cultures. However, our accident and emergency (A&E) department has been particularly problematic, with contamination rates consistently exceeding 3%. From Dawson’s review and other literature searches, it is clear that this is a universal problem and due to a large number of factors. To address this issue, we are planning a retraining programme of A&E staff as well as internal peer-review of blood-culturetaking techniques with colleagues and role models or ‘clinical champions’. However, we are concerned that feedback on contamination rates has the potential to negatively impact the confidence of staff in taking cultures and therefore may result in a reduction in numbers of cultures taken, as found by Thomas et al.4 In response to this concern, our feedback sessions will incorporate significant contribution from role models from within the clinical area concerned, to minimize risk of perceived external criticism, and to improve local ownership of the issue. Data will be collected to give
assurance that blood cultures continue to be collected in all appropriate clinical scenarios. We will re-audit contamination rates again next year and hope to see an improvement in the A&E data and a sustained low value in the inpatient rates. Conflicts of interest None declared. Funding sources None.
References 1. Dawson S. Blood culture contaminants. J Hosp Infect 2014;87:1e10. 2. Bamber AI, Cunniffe JG, Nayar D, Ganguly R, Falconer E. Effectiveness of introducing blood culture collection packs to reduce contamination rates. Br J Biomed Sci 2009;66:6e9. 3. 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. Archs Pathol Lab Med 1998;122:216e221. 4. Thomas S, Cheesborough J, Plumb S, et al. Impact of a blood culture collection kit on the quality of blood culture sampling: fear and the law of unintended consequences. J Hosp Infect 2011;78:256e259.
M. Shakeshaft* J. Cunniffe D. Harvey Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK * Corresponding author. Address: Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral, Merseyside CH49 5PE, UK. Tel.: þ44 (0) 151 678 5111; fax: þ44 (0) 151 604 0370. E-mail address: [email protected] (M. Shakeshaft). Available online 30 July 2014 http://dx.doi.org/10.1016/j.jhin.2014.07.007 Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved.
