Background: Accurately identifying the central venous catheter (CVC) as the source of bacteremia requires drawing simultaneous blood cultures (BC) from CVC and peripheral site and correct labeling of the source of the BC. In a busy emergency center (EC), 52% of BC collected from febrile cancer patients lacked the documented source information making the diagnosis and management of catheter-related bloodstream infections (CRBSI) challenging. We aimed to improve the diagnosis of CRBSI in our febrile cancer patients who present to our EC.
Methods: Between January 2015 and June 2015, we conducted a clinical safety and effectiveness project aiming to increase the occurrence of simultaneous BC drawing (one from the CVC and one from the peripheral site) with accurate labeling of site in the EC department by 10%. We measured the number of BC draws with proper labeling compared to the number of EC patients requiring BC, and the number of simultaneous BC draws with proper labeling compared to the number of EC patients with CVC requiring BC. We also evaluated the impact on the patients with positive blood cultures.
Results: Staff education along with monitoring increased average percentage BC source labeling from 48% to 70%. Implementation of a new label (Figure 1) along with healthcare staff education led to an increase in source labeling to 94% by end of June 2015, and this was sustained when reassessed in September 2015 (Figure 2). This project had a significant impact in patients with CVC and positive BC where the physician is now able to determine if the CVC is the source of the bacteremia in 62% of the cases compared to 22% at baseline (P=0.0006).
Conclusion: Education without an active intervention is usually not enough. Simple solutions such as label introduction can have significant impact to patient safety and care. Physicians can determine now if the CVC is the source of 62% of the bacteremia. Accurate diagnosis may guide the clinician at the bedside to appropriately manage the CVC in the setting of bacteremia, removing CVC when indicated and preventing unnecessary CVC removal with its potential safety and cost-effectiveness implications.
Figure 1. Blood Culture Label Indicating Specimen Source
Figure 2. Xbar Chart of Portion with Source Information by Stage.
A. M. Chaftari,
J. Adachi, None
R. Hachem, None
S. Raad, None
E. Natividad, None
N. Oliver, None
B. Elickalputhenpura, None
J. Tarrand, None
I. Raad, Merck: Grant Investigator , Grant recipient
Pfizer: Speaker's Bureau , Speaker honorarium
Allergan: Grant Investigator , Grant recipient
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