In 2005, the Neurological Intensive Care Unit (NICU) initiated a performance improvement project to decrease the contamination rate for peripheral blood cultures drawn by nurses. The goal was to comply with the UCSF laboratory threshold of no more than a 3% contamination rate and decrease antibiotic therapy usage associated with false positive blood cultures. We have successfully sustained the contamination reduction rate to an average of 1.2% in 2010.
The Department of Nursing is committed to optimizing patient quality of care by improving processes such as blood cultures that impact clinical outcomes, patient safety, and efficiency. Reducing unnecessary antibiotic therapy associated with false positives minimizes the associated side effects and risks, as well as, drug-resistant organisms. In addition, it provides cost savings with regard to nursing and pharmacy time associated with antibiotic processing, delivery, administration, monitoring, and interventions, as well as, the cost of antibiotics.
Front-line Staff Lead the Way
We believe the success of reducing blood culture contamination begins with staff engagement. In NICU, the multidisciplinary Blood Culture Performance Improvement (PI) Project Committee developed and implemented an in-service for nurses to heighten awareness of the problem and educate regarding correct technique and benefits of compliance. Interventions and tools were created to facilitate correct technique such as posters, a video, a case study and a competency-based module. A major contribution to the success of this project has been the nurses submitting and reviewing their own peripheral blood culture results from microbiology.
Utilizing Innovative Practices to Prevent Blood Culture Contamination
After analyzing NICU’s data, brainstorming ideas, and discussing strategies, the committee designed and implemented a plan that began with a literature review of evidence-based practices. After informal observation of NICU nurses drawing blood cultures, the committee found there were inconsistencies in technique. Also identified were contributing factors to inconsistent technique such as recent changes in the skill mix of NICU nurses, knowledge gaps regarding standardized procedure, lack of awareness of the consequences associated with not following the standardized procedure as well as accessibility of peripheral blood culture collection kit components. Once these issues were clearly identified, corrective actions to improve practice were successfully implemented.
Data Transparency and Analysis
NICU receives a monthly report from the microbiology lab with the peripheral blood culture contamination rate for the unit. These reports assist with sustaining the clinical blood culture process and outcomes by providing direct care staff visible results of their progress. Pre-implementation (2004) average peripheral blood culture contamination rate was 4.3% and post-implementation (2005) was reduced to 2.8%. As of 2010, the average blood culture contamination rate was 1.2%.
Team Members and Departments/Services:
Department of Nursing NICU Peripheral Blood Culture PI Project Committee:
Jennifer Pacholuk, NICU Unit Educator – Team Lead
Scott Jensen, RN
David Turner, RN
Tina Mammone, Unit manager
Sylvia Andrade, Unit assistant manager
Elizabeth Sin, Unit assistant manager
Marylou Muwaswes, Clinical Nurse Specialist
NICU Identified Experts:
NICU Nursing Leadership group
Microbiology - Rohan Nadarajah, MT (ASCP), Senior supervisor
Pharmacy - Deepa Setty, Pharm.D