Initial Specimen Diversion Devices for Emergency Department Blood Cultures May Reduce Contamination Rates and Costs:...

Emergency departments (ED) are a primary site of blood culture collection in the United States. High rates of blood culture contamination, commonly seen in EDs, are associated with diagnostic inaccuracy, unnecessary antibiotic use, and increased costs. In this structured literature review, we evaluated the effectiveness of initial specimen diversion devices (ISSDs), which are attached to the needle tip and discard the initial 0.15-1.5 mL of blood. We paid particular attention to their applicability in reducing blood culture contamination in adult ED patients in rural healthcare settings. The average cost of an ISDD is $15-$30, and this upfront cost creates a significant barrier in rural EDs, which face resource scarcity.

In this review of primary literature from 2021-2025, we evaluated the efficacy of ISDD in lowering blood culture contamination rates in adult patients in the ED. Our primary outcome was the change in contamination rates after introduction of the ISDD. Secondary outcomes included changes in vancomycin duration of therapy, hospital length of stay, and total hospital costs.

We screened 460 records across PubMed, EBSCO, and Embase. Eight papers were selected for full review, from 10 hospital systems. All studies demonstrated a decrease in the rates of blood culture contamination with the ISDD. Contamination rates were reduced by an average of 2.89% across all 10 study locations. Only three of 10 hospitals (30%) achieved a blood culture contamination rate below 1%. One rural community hospital saw an absolute reduction of BCCs from 3.94% to 1.05%. Another study reported a decrease in total yearly hospital costs from $1,120,000 to $383,690, and another reported a 31.4% reduction in mean duration of vancomycin therapy.

This review shows the clinical value of ISDDs to reduce blood culture contamination, and highlights the need for further research into scalable implementation strategies, especially in resource-constrained systems, like rural hospitals.