Eliminating Blood Culture False Positives: Harnessing the Power of Nursing Shared Governance

Our emergency department struggled with unacceptable blood culture contamination rates for several years. The objective of this project was to create a self-governing culture within nursing that would generate and sustain the achievement of monthly blood culture contamination rates below the national benchmark of 3% and the hospital laboratory acceptable threshold of 2.3%.

The ED shared governance council partnered with the laboratory team to review the monthly epidemiology reports for all adult and pediatric ED patients having blood cultures performed from January 2010 through December 2015. A written competency assessment test completed by ED personnel performing phlebotomy showed opportunity for improvement. After a review of the literature, a blood culture collection education tool was created and implemented. The final step was to design a monthly monitoring and peer-review process to perform ongoing causal analysis with those individuals who were linked with contaminated specimens.

The evidence shows that the new process decreased the blood culture contamination rate from a baseline rate of 5.37% to 1.76%.

The chief recommendation is to engage staff through clinical leadership. This quality-improvement project translates to improved patient care and a reduction in unnecessary treatment and costs.