Multicenter Blood Culture Quality Improvement
| Status: | Completed |
|---|---|
| Conditions: | Infectious Disease, Hematology |
| Therapuetic Areas: | Hematology, Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/27/2013 |
| Start Date: | August 2011 |
| End Date: | December 2012 |
| Contact: | Wesley H Self, MD |
| Email: | wesley.self@vanderbilt.edu |
| Phone: | 615-936-0253 |
Multicenter Implementation of a Quality Improvement Program to Reduce Blood Culture Contamination in the Emergency Department
False positive blood culture results due to specimen contamination with bacteria inhabiting
patients' skin is a common problem in emergency departments (EDs) in the United States.
Contaminated blood cultures lead to patient harm through unnecessary hospitalizations and ED
visits, delays in surgery, unneeded antibiotics, and unnecessary procedures. The
investigators have developed a multifaceted quality improvement improvement bundle (The
Blood Culture QI Program) designed to minimize blood culture contamination in the ED. In
this study, the investigators will implement the quality improvement bundle in six community
hospital EDs and evaluate its effectiveness at reducing contamination.
The Blood Culture QI Program has four components: (1) education: content knowledge and
standardized experiential training on sterile technique designed for ED nurses; (2) process
redesign: change in patient safety attitude and conversion of blood culture collection from
a clean to a sterile technique; (3) checklist use: reinforcement of optimal blood culture
collection technique at the point of care; (4) feedback: systematic charting and reporting
of contamination rates to the ED nurses who collect cultures. In order to convert blood
culture collection into a fully sterile procedure, the investigators developed the Sterile
Blood Culture Collection Kit, a novel materials kit that contains the equipment needed to
collect a culture using sterile technique, including: (1) a 3ml solution of 2% chlorhexidine
gluconate - 70% isopropyl alcohol (Chloraprep, CareFusion) skin prep device; (2) a sterile
drape; (3) a sterile needle; and (4) gauze.
The investigators will evaluate the effectiveness of the Blood Culture QI Program after
implementing it in six community hospital EDs. Our study will compromise six replications of
an interrupted time series study wherein each replication will be powered for internal
validity to test the hypothesis of decreasing the contamination rate by 50% at each site. A
stepped wedge (also called multiple baseline) design will be used to implement the program
across hospitals to evaluate the generalizability (external validity) of program
effectiveness. The primary analysis will be an interrupted time series analysis at each
site comparing the proportion of ED blood cultures contaminated during a post-implementation
intervention period with a pre-intervention baseline period.
Inclusion Criteria:
- Patients who have a blood culture ordered for clinical purposes in one of the
participating centers during the study period.
Exclusion Criteria:
- Age < 18 years old
We found this trial at
2
sites
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