A Quality Improvement PDSA to Evaluate the Effectiveness of Blood Diversion Using a Three-Way Connector During Blood Culture Collection
Blood culture contamination is a significant issue in clinical settings as it can contribute to patient harm and increased healthcare burdens. Reducing contamination rates through improved collection techniques is essential to enhancing patient safety and healthcare efficiency. One method proven to improve blood culture contaminations is using the initial specimen diversion technique during blood culture collection. Our PICOT question was: Does the use of a discard of 1.5 mL to 2.0 mL when drawing peripheral blood cultures without a commercial sterile closed system device decrease false-positive contamination in the York Street campus Medical Intensive Care unit over 1 year with a designated BCT (Blood Culture Team) compared to no discard? From January to December 2022, we implemented a quality improvement project using the plan-do-study-act (PDSA) approach. This initiative evaluated the effectiveness of blood diversion with a three-way connector during blood culture collection as opposed to using commercially available sterile devices. We reeducated the blood culture team on specimen diversion using a standard operating procedure and repeat demonstrations. All blood culture contaminations were tracked via system dashboard with reviews conducted on each incident. We also held regular check-ins during the first 12 weeks of the pilot. A total of 2,443 samples were collected using the specimen diversion technique compared to 2,558 samples collected with the traditional method during the pilot phase (Figure 1). In this period, there were 38 contaminations resulting in a median contamination rate of 1.56 for the diversion method, contrasted with 61 contaminations and a median rate of 2.38 for the pre-intervention phase (Figure 1). A Pearson’s chi-squared test was conducted with a 95% confidence interval, resulting in a P-value of 0.035, indicating a statistically significant difference between the contamination rates for the years 2021 and 2022 (Figure 1). The likelihood ratio of contamination occurring by chance was calculated at 0.035, further supporting the significance of our findings (Figure 1). This quality improvement study reports a 34.45% reduction in contamination rates using the initial specimen blood diversion technique. Although there was a significant decrease in the rate of contamination, we were unable to achieve a rate of less than 1.0% without a sterile closed system device.Abstract
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