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Changing the needle when inoculating blood cultures. A no-benefit and high-risk procedure
M K Leisure1, D M Moore, J D Schwartzman
1Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908.
Abstract:
Although the Centers for Disease Control recommends that needles should never be recapped, many phlebotomists routinely recap and change needles before blood culture inoculation. This study compared the extrinsic contamination rate in blood cultures when the needle was and was not changed. One hundred eight medical students obtained 182 blood specimens from each other by means of standard methods. Each specimen was inoculated into two culture bottles. The first bottle was inoculated with the needle used for phlebotomy, and the second was inoculated after needle change. Four (2.2%) of 182 bottles were contaminated when the needle was not changed, compared with one (0.6%) when the needle was changed. This small difference was not statistically significant, and the likelihood of having failed to detect a 5% difference in contamination rate was small. The risk of needle-stick injury incurred by changing the needle before inoculation of blood culture bottles seems to be unjustified.
Insights
Changing needles before blood culture inoculation did not significantly reduce contamination rates. The Centers for Disease Control and Prevention
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Patient Safety
Background:
- The Centers for Disease Control and Prevention (CDC) advises against recapping needles.
- Phlebotomists often recap and change needles before blood culture collection.
- Needle recapping and changing practices may influence blood culture contamination rates.
Purpose of the Study:
- To compare the extrinsic contamination rates of blood cultures when needles are changed versus not changed before inoculation.
- To evaluate the clinical significance of needle manipulation in blood culture collection.
Main Methods:
- A comparative study involving 108 medical students.
- 182 blood specimens were collected using standard phlebotomy techniques.
- Each specimen was inoculated into two blood culture bottles: one with the original phlebotomy needle, and one after needle change.
Main Results:
- A contamination rate of 2.2% (4/182) was observed when the needle was not changed.
- A contamination rate of 0.6% (1/182) was observed when the needle was changed.
- The difference in contamination rates between the two methods was not statistically significant.
Conclusions:
- Changing needles before blood culture inoculation does not significantly reduce contamination.
- The risk of needle-stick injury from changing needles outweighs the minimal observed benefit.
- Current phlebotomy practices regarding needle manipulation for blood cultures may warrant re-evaluation.