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Improving adherence to facility protocol and reducing blood culture contamination in an intensive care unit: A
Mei He1, Sufang Huang1, Jie Xiong1
1Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Qiaokou District, Wuhan, China.
Background:
Blood culture contamination (BCC) is a safety and quality indicator for intensive care units (ICUs). BCC rates in our ICU ranged from 2.90% to 6.70% in 2017.
Objective:
This quality improvement project aimed to reduce the contamination rate from a mean of 4.52% to <3.0% in 1 year by improving the adherence of nurses to the facility protocol during blood collection.
Methods:
This project used a before-after design. It was conducted by a leadership team in a 32-bed ICU where approximately 4000 cultures are drawn annually. We observed the performance of ICU nurses during blood collection, interviewed them regarding the difficulties they encountered with protocol adherence, and conducted a cause-and-effect analysis to identify the main problems. Based on a literature review, we developed and implemented a countermeasure protocol, including a standardised medical order, an online learning program, a weekly departmental report and individual feedback routine, and phlebotomy training to address these problems in 2 months.
Results:
The interview results indicated that blood contamination resulted from the environment, difficult phlebotomy, and the inadequate knowledge and skill of the nurses. The countermeasure protocol reduced the average BCC rate from 4.52% to 2.59% during the intervention period and to 0.59% during the 10-month postintervention period. Nursing adherence to the standard protocol for blood culture collection also improved.
Conclusions:
BCC in ICUs is multifactorial. By optimising the work environment, offering skill training, and reinforcing education and individualised feedback, we successfully reduced BCC in our unit to a sustainable low rate.
Insights
Implementing a new protocol significantly reduced blood culture contamination (BCC) in intensive care units (ICUs). This quality improvement initiative lowered BCC rates, enhancing patient safety and care quality.
Area of Science:
- Healthcare Quality Improvement
- Infection Control
- Clinical Microbiology
Background:
- Blood culture contamination (BCC) is a critical indicator of safety and quality in intensive care units (ICUs).
- Observed BCC rates in the ICU ranged from 2.90% to 6.70% in 2017, necessitating targeted interventions.
Purpose of the Study:
- To decrease the mean BCC rate from 4.52% to below 3.0% within one year.
- To enhance nursing adherence to established protocols for blood collection in the ICU setting.
Main Methods:
- A before-and-after study design was employed in a 32-bed ICU.
- Interviews and performance observations identified challenges; a literature review informed a countermeasure protocol including standardized orders, online learning, feedback, and phlebotomy training.
Main Results:
- The intervention reduced the average BCC rate from 4.52% to 2.59% during the intervention period.
- Post-intervention, the BCC rate further decreased to 0.59% over 10 months.
- Improved nursing adherence to blood culture collection protocols was observed.
Conclusions:
- Blood culture contamination in ICUs is influenced by multiple factors, including the environment, phlebotomy technique, and nursing knowledge/skills.
- Optimizing the work environment, providing targeted training, and reinforcing education with feedback can sustainably reduce BCC rates in ICUs.
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