Missed Opportunities for Cultures During Operating Room Procedures

Background: Invasive procedures often represent opportunities to obtain specimens for microbiological analysis to establish the infectious nature of a lesion, to identify pathogen(s), or to test susceptibility of pathogen(s) to antimicrobials.  Yet, these opportunities are often overlooked or specimens are not obtained.  We analyzed a sample of procedures to estimate the frequency of these missed opportunities. 

Methods: We identified all procedures done in operating rooms at MVAHCS from January 2011 to December 2012.  We selected 664 procedures that seemed likely to involve infectious processes from the name given to the procedures.  We then extracted information from medical records from 165 of these cases. 

Results: Specimens were sent for microbiological analysis in 91 (55%) of the 165 cases (Table 1). 

Table 1
	Specimen for Microbiology n(%)
Procedure	No	Yes	Total
Wound I&D	41 (45)	51 (55)	92
Abscess I&D	15 (58)	11 (42)	26
Joint potential infection	4 (24)	13 (76)	17
Joint, prosthetic, potential infection	2 (15)	11 (85)	13
Abdomen, potential infection	7 (78)	2 (22)	9
Bone infection I&D	2 (50)	2 (50)	4
Other	3 (75)	1 (25)	4
Total	74 (45)	91 (55)	165

In 34 (46%) of the 74 cases in which specimens were not sent, the absence of microbiological information limited subsequent management decisions.  In 83 (91%) of the 91 cases in which specimens were sent, the microbiological information aided subsequent management decisions.  Providers intended beforehand that specimens would be sent in 131 (79%) of the 165 cases, but they were actually sent in only 90 (69%) of these cases.  In the remaining 31 cases in which providers did not intend before the procedure that specimens would be sent, specimens were sent in only one case. 

Conclusion: During 165 operating room procedures in cases where microbiological samples were likely to influence management, specimens were sent in only 55% of cases.  In some cases, microbiological analysis was planned but specimens were not sent. In other cases, it appeared that the potential value of microbiological analysis did not occur to providers.  Procedures should be designed and tested to improve the likelihood that specimens will be sent for microbiological analysis during procedures where the results might impact management.