A Quality Improvement Initiative to Reduce Blood Culture Contamination in the Neonatal Unit
Date
2021
Authors
Allen, E.
Cavallaro, A.
Keir, A.K.
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Advisors
Journal Title
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Type:
Journal article
Citation
Pediatric Quality & Safety, 2021; 6(3):e413-1-e413-6
Statement of Responsibility
Elizabeth Allen, Angela Cavallaro, Amy K. Keir
Conference Name
Abstract
Introduction: Peripheral blood culture contamination (BCC) can lead to an initiation of unnecessary antimicrobial treatment, further laboratory tests, increased length of stay, and increased costs. This study describes a 12-month quality improvement (QI) program to reduce the BCC rate in a neonatal unit by 50%. Methods: The QI team focused on standardizing processes to align with best practices using process mapping and cause and effect diagrams. Plan-Do-Study-Act (PDSA) 1: inoculation of blood culture bottles with the introduction of transfer device; PDSA 2: preparation of the skin for peripheral intravenous cannula insertion; PDSA 3: aseptic technique education package; and PDSA 4: optimizing blood volume of blood collected for culture. The team used statistical process control methodology to detect special cause variation. Results: Compliance with the standard processes as part of PSDA 1 improved from a mean level of 50% to 100% and for PDSA 2 improved from a mean level of 50% to 95%. After implementation of PDSA 3, scores on a relevant knowledge test increased from a mean of 39% (pretraining test; n = 10) to 92% (posttraining test; n = 10) (P < 0.001). Postimplementation of the processes for PDSA 4, a minimum of 1 mL was collected in 94% of blood culture collection events (n = 450) (mean 1.1 mL; range 0.5–3.5 mL). Special cause variation occurred after the implementation of the PDSA cycles. During the baseline period, the BCC rate was 2.0% and decreased to 1.0% postinterventions implementation. Conclusions: Interventions focused on standardizing practices around collection of blood cultures in neonates were associated with fewer contaminants. This study is reported according to the SQUIRE 2.0 guidelines.
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Description
Published online May 19, 2021
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Rights
© 2021 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.