991. Establishing Best Clinical Practice in Blood Culture Collection- Successful Implementation of a Multimodal Quality Improvement Strategy in a Public Hospital in Auckland
Session: Poster Abstract Session: Diagnostic Microbiology: Quality Improvement and Rapid Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Posters
  • POSTER Best Clinical Practice in Blood Culture (Rupert Murch) .pdf (6.9 MB)
  • Background: Utility of blood cultures (BC) for accurate diagnosis of bloodstream infections can be improved by obtaining at least 2 sets from separate venepunctures when clinically indicated, and by minimising the risk of contamination using strict aseptic techniques.

    Methods: A quality improvement initiative was undertaken in 2014 at North Shore Hospital, Auckland, a 550 bed acute care facility with about 1000 BC’s performed monthly and an 8-10% positivity rate. Baseline information about BC contamination rate, staff attitude and practice towards performing BC, and cost estimates for BC was obtained between January till September 2013. Using FAST (Find, Analyse, Solve, Track) methodology, this quality initiative was aimed at standardising best BC practice across the hospital. Multimodal strategies with an initial focus on Emergency (ED) staff included best BC practice training using a newly developed e-learning module, establishing a local blood culture policy, promotion and provision of BC drawing kits and aseptic non-touch technique (ANTT), and encouraging clinicians to incorporate these changes in practice. Analysis was then repeated between July till December 2014 to compare with baseline data. 

    Results: During the baseline period, contamination rate was 2.6%. Of the 599 positive BC, 177 (29.5%) were considered contaminants. Overall, Coagulase negative Staphylococci (CoNS) was the most prevalent isolate (29%). Majority (78%) of positive BC were collected as a single set. Only 28-32% of ED staff surveyed had formal training or awareness of best BC practice technique. In post-intervention period, reduction in contamination rate to 1.8% was achieved, and CoNS contributed to 21% of 654 positive BC. A cumulative increase of 3.5% was noted in isolation of common pathogens (E.coli, S.aureus, Klebsiella sp). Yield of BC was 5.5%, 8.1% and 14.3% from 1, 2 and 3 sets respectively. Reduction in single set positive BC to 60%, estimated cost saving of NZ$143K (USD 125K) and improved knowledge/ awareness in staff resurveyed was also observed.

    Conclusion: A significant reduction in blood culture contamination rate was achieved through a multimodal program, associated with improved clinical practice, awareness and cost savings.

    Hasan Bhally, Infectious Diseases Physician1, Rupert Murch, Clinical Nurse Educator2, Dragana Drinkovic, Clinical Microbiologist2, Annette Bissett, Lead phlebotomist2 and Ken Kok, Quality Improvement specialist2, (1)Medicine and Infectious Diseases, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand, (2)Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand

    Disclosures:

    H. Bhally, None

    R. Murch, None

    D. Drinkovic, None

    A. Bissett, None

    K. Kok, None

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