Background: Septicemia is a major cause of death in the United States and accounts for up to $16.7 billion in annual health care expenses. Blood culture is the gold standard for laboratory diagnosis of bacteremia and resultant septicemia; however, false positive blood cultures hinder the accurate determination of true bacteremia with often serious implications. The goal of this study was to determine the efficacy of collecting a 1 mL discard in a red tube prior to blood culture collection and to assess its effectiveness in reducing contamination rates in Hartford Hospital Emergency Department (HHED).
Methods: During the months of June to December 2017 blood cultures were collected by the phlebotomy team using ChloraPrep (chlorhexidine) as the sole disinfecting agent. Blood cultures consisted of BD BACTEC plus Aerobic/F and BD BACTEC Lytic/10 Anaerobic drawn at the same time and monitored on BD BACTEC FX instrument for 5 days. Prior to collecting blood cultures 1 mL of blood was collected in a red top tube and discarded. Monthly and overall contamination rates were then compared to 2016 in which a red top discard tube was not used.
Results: During June to December 2016 there were a total of 9,576 blood cultures collected with a total of 178 contaminants and an overall contamination rate of 1.9%. During June to December 2017 there were a total of 9,133 blood cultures collected with a total of 73 contaminants and an overall contamination rate of 0.8%. During both years our contamination rates were well below the CLSI recommendation; however, a significant reduction in blood culture contamination was observed after the use of a Red Top discard tube (0.8% vs 1.9%) (Fig. 1-3).
Conclusion: The cost of a standard blood draw with Red Top tubes is minimal (few cents) while a single collection using an initial specimen diversion device (ISDD) can range from $15-18. During the course of this study the use of a standard Red Top discard cost approximately $456 (2017); if an ISDD was used instead this would have generated $136,995 in healthcare cost. At our institution we were able to keep our contamination rates below 1% after the implementation of a standard Red Top discard tube. This suggests that the use of a Red Top discard prior to blood culture collection is an effective means for reducing and maintaining a low blood contamination rate.
J. Aslanzadeh, None