Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study
Open accessAbstract
Objectives: Blood culture contamination is a common problem in the emergency department (ED) that leads to unnecessary patient morbidity and health care costs. The study objective was to develop and evaluate the effectiveness of a quality improvement (QI) intervention for reducing blood culture contamination in an ED. Methods: The authors developed a QI intervention to reduce blood culture contamination in the ED and then evaluated its effectiveness in a prospective interrupted times series study. The QI intervention involved changing the technique of blood culture specimen collection from the traditional clean procedure to a new sterile procedure, with standardized use of sterile gloves and a new materials kit containing a 2% chlorhexidine skin antisepsis device, a sterile fenestrated drape, a sterile needle, and a procedural checklist. The intervention was implemented in a university‐affiliated ED and its effect on blood culture contamination evaluated by comparing the biweekly percentages of blood cultures contaminated during a 48‐week baseline period (clean technique) and 48‐week intervention period (sterile technique), using segmented regression analysis with adjustment for secular trends and first‐order autocorrelation. The goal was to achieve and maintain a contamination rate below 3%. Results: During the baseline period, 321 of 7,389 (4.3%) cultures were contaminated, compared to 111 of 6,590 (1.7%) during the intervention period (p < 0.001). In the segmented regression model, the intervention was associated with an immediate 2.9% (95% confidence interval [CI] = 2.2% to 3.2%) absolute reduction in contamination. The contamination rate was maintained below 3% during each biweekly interval throughout the intervention period. Conclusions: A QI assessment of ED blood culture contamination led to development of a targeted intervention to convert the process of blood culture collection from a clean to a fully sterile procedure. Implementation of this intervention led to an immediate and sustained reduction of contamination in an ED with a high baseline contamination rate.
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Impact of an Educational Intervention on BPPV Management: An Interrupted Time Series Analysis
Arbab, E., Passi, K., & Ohle, R. (2025) · Algorithms · doi:10.3390/a18100606 · Cited by 1 · see citing works
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Conhecimentos, Atitudes e Práticas dos enfermeiros sobre colheita de hemocultura
Ruiz, J. S., Frota, O. P., & Júnior, M. A. F. (2024) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2023-0424pt · Cited by 1 · see citing works
New Solutions to Decrease Blood Culture Contamination
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Optimizing blood and urine cultures: Diagnostic stewardship in the emergency department
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Risk factors of sepsis in premature infants
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Blood Culture Contamination Dramatically Lowered by Change in Technique
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G-control Charts for Contamination Rates of Blood Cultures in a University Hospital
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A Five-Bundle Intervention to Improve Blood Culture Use in a Tertiary Hospital in Romania
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Visual Analytics in Healthcare Resource Optimization: A Tableau-Based Case Study in India
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A retrospective analysis of emergency department cultures in a tertiary care center
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- Authors
- Self, W. H., Speroff, T., Grijalva, C. G., McNaughton, C. D., Ashburn, J., Liu, D., Arbogast, P. G., Russ, S., Storrow, A. B., & Talbot, T. R.
- Affiliations
- Vanderbilt University (US)
- Kaiser Permanente (US)
- Corresponding author
- Self, Wesley H.
- ORCID
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2013-01
- Volume
- 20
- Issue
- 1
- Pages
- 89-97
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- PMC
- PMC3623801
- OpenAlex
- W1997054653
- Cited by
- 92
- References
- 26
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 8 · 2023: 4 · 2022: 5 · 2021: 10 · 2020: 7 · 2019: 7 · 2018: 12 · 2017: 8 · 2016: 6 · 2015: 8 · 2014: 6 · 2013: 3
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (KL2TR000446, UL1TR000445)
- National Heart, Lung, and Blood Institute (K12HL109019)
- National Center for Research Resources (UL1RR024975)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- blood culture contamination, surgical asepsis, emergency department, procedural checklist, quality improvement intervention, contamination rate reduction
- MeSH terms
- Antisepsis, Blood, Blood Specimen Collection, Chlorhexidine, Emergency Service, Hospital, Equipment Contamination, Female, Humans, Male, Prospective Studies, United States, Quality Improvement
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