Continuous quality improvement for introduction of automated blood culture instrument

Despite the critical nature and high cost of blood cultures, hospitals rely on manufacturers' test site data. As a result, in-hospital testing and compliance evaluation of newly acquired instruments are seldom done. The goal of this study was to apply a continuous quality improvement approach and to develop assessment criteria for all stages from the purchase order, through the on-site instrument evaluation, to the compliance evaluation. Despite the introduction of an automated high-blood-volume instrument (BacT/Alert) in our hospital, 56% of adult patients had only one venipuncture and 89.5% had < or = 20 ml of total blood volume sampled. False positives were associated with overfilling of bottles. These problems occurred because the phlebotomists did not like to perform multiple venipunctures on ill patients; therefore, they were drawing 20 ml of blood from one venipuncture and splitting it between two bottles. Unknown to the staff, the vacuum in the bottles draws significantly more than 10 ml of blood; therefore, the first bottle in the set was frequently overfilled and the second bottle was frequently underfilled. A diagrammatic guideline for a new blood culture protocol based on two venipunctures, taken one immediately after the other, to inoculate three bottles was developed. Compliance evaluation demonstrated that within 1 month of starting the new protocol, 74% of patients had at least two or more venipunctures and 60% had > or = 30 ml of blood drawn per patient episode. This study demonstrates the need for continuous quality improvement, including compliance evaluation, to ensure that the potential benefits of newer blood culture technology are actually realized.