Reducing the Blood Culture Contamination Rate in a Pediatric Emergency Department and Subsequent Cost Savings

Posted by Joelle N. Simpson MD, MPH

Welcome to the first Article of the Week for 2013! I chose an article from Pediatrics titled: “Reducing the Blood Culture Contamination Rate in a Pediatric Emergency Department and Subsequent Cost Savings.” (Hall R T et al. Pediatrics 2013;131:e292-e297). 

I was drawn to this article for its simplicity in design and its relevance to our practice. This study was performed at Monroe Carell Jr. Children’s Hospital at Vanderbilt Emergency Department with an annual census of 52,000 patients.  It would be interesting to note the $$ cost of our false positive rates for blood cultures drawn in our ED and how we can implement interventions to reduce that cost similar to this.

HYPOTHESIS: The introduction of a standardized sterile collection process would reduce the pediatric emergency department’s peripheral blood culture contamination rate and unnecessary use of resources.

METHODS: A sterile blood culture collection process (see chart below) was designed by analyzing current practice and identifying areas in which sterile technique could be introduced. To spread the new technique, a web-based educational model was developed and disseminated. Subsequently, all nursing staff members were expected to perform peripheral blood cultures by using the modified sterile technique. 

RESULTS: The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period (P < .0001), with yearly estimated savings of ∼$250 000 in hospital charges (see graph below). 

CONCLUSIONS: Subsequent to the intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter.