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Blood culture contamination: a randomized trial evaluating the comparative effectiveness of 3 skin antiseptic
Laraine L Washer1, Carol Chenoweth, Hae-Won Kim
1Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. laraine@med.umich.edu
Objective:
To determine relative rates of blood culture contamination for 3 skin antisepsis interventions-10% povidone iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% chlorhexidine gluconate in 70% isopropyl alcohol (CHG)-when used by dedicated phlebotomy teams to obtain peripheral blood cultures.
Design:
Randomized crossover trial with hospital floor as the unit of randomization.
Setting:
Teaching hospital with 885 beds.
Patients:
All adult patients undergoing peripheral blood culture collection on 3 medical-surgical floors from May 2009 through September 2009.
Intervention:
Each antisepsis intervention was used for 5 months on each study floor, with random crossover after a 1-month washout period. Phlebotomy teams collected all peripheral blood cultures. Each positive blood culture was adjudicated by physicians blinded to the intervention and scored as a true positive or contaminated blood culture. The primary outcome was the rate of blood culture contamination for each antisepsis agent.
Results:
In total, 12,904 peripheral blood culture sets were evaluated, of which 735 (5.7%) were positive. There were 98 contaminated cultures, representing 13.3% of all positive cultures. The overall blood culture contamination rate for the study population was 0.76%. Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics ([Formula: see text]), yielding 0.58% with PI (95% confidence interval [CI], 0.38%-0.86%), 0.76% with IT (95% CI, 0.52%-1.07%), and 0.93% with CHG (95% CI, 0.67%-1.27%).
Conclusion:
Choice of antiseptic agent does not impact contamination rates when blood cultures are obtained by a phlebotomy team and should, therefore, be based on costs or preference.
Trial Registration:
ClinicalTrials.gov identifier: NCT01216761 .
Insights
When phlebotomy teams collect blood cultures, skin antiseptic choice (povidone-iodine or chlorhexidine) does not affect contamination rates. Cost or preference should guide antiseptic selection for these procedures.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Patient Safety
Background:
- Blood culture contamination is a significant issue impacting patient care and healthcare costs.
- Standardizing skin antisepsis protocols is crucial for accurate diagnostic results.
- Dedicated phlebotomy teams may influence the effectiveness of different antiseptic agents.
Purpose of the Study:
- To compare the blood culture contamination rates associated with three skin antisepsis agents: 10% povidone-iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% chlorhexidine gluconate in 70% isopropyl alcohol (CHG).
- To evaluate these agents when used by specialized phlebotomy teams for peripheral blood culture collection.
Main Methods:
- A randomized crossover trial design was employed, with hospital floors serving as the unit of randomization.
- The study included adult patients undergoing peripheral blood culture collection across three medical-surgical floors over a five-month period.
- Phlebotomy teams administered each antisepsis intervention sequentially, with blinded adjudication of positive blood cultures to determine contamination.
Main Results:
- A total of 12,904 peripheral blood culture sets were analyzed, with an overall contamination rate of 0.76%.
- Contamination rates did not significantly differ among the three antiseptics: PI at 0.58%, IT at 0.76%, and CHG at 0.93%.
- These findings indicate no statistically significant impact of the antiseptic agent on blood culture contamination when collected by phlebotomy teams.
Conclusions:
- The choice of skin antiseptic agent does not appear to influence blood culture contamination rates when collections are performed by dedicated phlebotomy teams.
- Antiseptic selection for blood cultures should be based on factors such as cost-effectiveness and clinician preference.
- These results support flexibility in antiseptic choice for phlebotomy teams, potentially optimizing resource allocation.
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