Changing the paradigm: Are two sets of blood cultures always needed?

We describe a multifaceted intervention deployed amidst a blood culture (BC) bottle shortage and its impact on BC yields.

Cross-sectional study conducted at a large safety-net hospital. BC bottle conservation strategies focused on improving blood volume collection, discouraging orders for low-yield conditions, limiting BC orders to 1 set per patient and restricting repeat BC to greater than 48-hour intervals. Trends in BC positivity rates and bloodstream infection events were analyzed using control charts, with a 13-month baseline period, and 12-month intervention period.

A total of 35,449 BCs were analyzed. The overall median percent positivity increased from 8.6% to 12.6% (P = .001). In the Emergency Department, the median percent positivity rose from 12.4% to 14.3% (P = .03); in Intensive Care Units (ICU), from 6.8% to 11.6% (P = .001); and in Medical-Surgical units, from 4.9% to 9.0% (P = .001). No significant variability in the counts of positive BCs was observed. The median blood volume per set increased from 5.7 to 7.5 mL (P = .001). Vancomycin use and acute ICU transfers remained stable.

The implementation of BC bottle conservation measures did not negatively impact BC yields or patient safety indicators. Prospective studies are needed to re-evaluate traditional BC ordering and collection practices.