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Learning Objective 1: Describe proper technique to obtain blood cultures & IV starts
Learning Objective 2: Identify financial implications for contaminated blood cultures & patient care in the Emergency Department setting
Blood Culture contamination has been confirmed to increase the cost of patient care, overuse of unnecessary antibiotics and increase the length of stay. The purpose of the study was to determine if contamination rates can be reduced following education of the nurses about the proper technique to use when initiating an IV & drawing blood cultures using evidence based practice.
This was a quality improvement project with a comparison of contamination rates before and after the implementation and education of the modified blood draw protocol.
This study was completed in a 220 bed non-profit , teaching hospital. The ED volume was 51,000 for FY 09, averaging over 446 blood cultures per month.
Participants/Subjects: All nursing staff in the ED received the education. All patients, regardless of age, received an IV and blood cultures drawn if ordered.
Methods: The project design is quasi experimental. IRB approval was obtained. The variables were the contaminated blood cultures and the nurse. The Microbiology Department tracked the contamination rates & provided data to the project team monthly.
Results/Outcomes: FY 2008, ED contamination rate was 2.6% compared to the hospital rate of 2.3%. The first 8 months of FY 2009, ED contamination rate was 3.1%, compared to the hospital rate of 1.8%. National benchmark is 2.7 %. Four months post education , the average ED contamination rate is 1.9 % compared to the hospital average of 2.14%.December 2010 Blood contamination rate is 1.1% in the ED and the team has been able to sustain the improvements.
Implications: This reduction in blood culture contaminations results in improved care for 5-6 patients & cost savings of estimated $5,506 per patient. With a reduction in blood culture contaminations , it means better quality of care for patients, beds freed up for ED Admissions & cost savings for the patient & organization.