A QUALITY IMPROVEMENT INITIATIVE ON REDUCING BLOOD CULTURE CONTAMINATION IN THE EMERGENCY DEPARTMENT

Introduction: Contaminated blood cultures may have detri-mental effects on patients, the organization, and antimicrobial stewardship. Patients in the emergency department may need blood cultures collected before antimicrobial therapy. Contam-inated blood culture samples may contribute to prolonged hos-pital stay and also are associated with delayed or unnecessary antimicrobial therapy. This initiative aims to improve the emer-gency department's blood culture contamination rate that will eventually benefit the patients who will receive timely and proper antimicrobial therapy, and benefit the organization fiscally. Methods: This quality improvement initiative used the Define-Measure-Analyze-Improve-Control (DMAIC) process. The organization targets blood culture contamination rate of <= 2.5%. Control charts were used to study how blood culture contamination rate changed over time. In 2018, a workgroup was formed to work on this initiative. Improved site disinfection using 2% Chlorhexidine gluconate cloth before the standard procedure of blood culture sample collection was initiated. Chi squared test of significance was used to compare blood cul-ture contamination rates 6 months before and during feedback intervention as well as contamination rate from source of blood draw. Results: Blood culture contamination rates 6 months before and during feedback intervention showed significant decrease (3.52% before intervention and 2.95% after intervention; P < .05). Contamination rates differed significantly based on the source of blood culture draw (7.64% via line, 3.05% via percutaneous venipuncture, and 4.53% via other; P < .01). Discussion: Blood culture contamination rate continued to decrease with the use of a predisinfection process with 2% Chlorhexidine gluconate cloth before blood sample collection process. Practice improvement also was evident with effective feedback mechanism.