I was interested in your presentation because my facility also had this same issue. Our facility’s answer was to only allow phlebotomist to draw blood cultures. It’s great because it’s targeted to a limited amount of people, so training can be applied specifically to them. If blood culture contamination is still an issue, it’s easier to know where the fail is located. The downside of this is clearly that it often causes for more patient sticks. You have to weigh your pros and cons, risk more contaminated blood cultures causing increased patient stays and cost or inconvenience the patient for another stick. It would just be culturally evaluated I’m sure. In your scenario, having only one phlebotomist available would make this more difficult, but if you said they had to be present with every draw anyhow, then they should just be the ones doing it. It could then free up your ED staff for other needs. Would there be another reason this wouldn’t work? I suppose if you are drawing with IV access, this would be unrealistic. That is where the additional stick comes in. However, if you’re waiting for their presence to start an IV for the draw, then it could be delaying patient care. There is just a lot to consider and evaluate. I wonder in your current facility the amount of contaminated blood draws that occurred from nurses/technician draws versus phlebotomist draws. There could be a trend to target if they were able to collect that data. I think the checklist is a wise idea though. It’d be a good reminder and then become habit of the required blood culture steps. One article I viewed, that I think you also referenced, likewise used a procedural checklist that was included with a blood culture drawing kit. It had sterile supplies of sterile gloves, skin prep, drape and needle (Self et al., 2013). I thought that was a wise idea. Their trial period seen a decrease from 4.3% to 1.7% with that intervention (Self et al., 2013). It would be more costly to include the kit though, but could be worth it. I’m really curious to see how your implementation comes out. Good luck! Sorry for such a long response, it just really got my brain ticking. Great topic choice.
Reference
Self, W.H., Speroff, T., Grijalva, C.G., McNaughton, C.D., Ashburn, J., Liu, D., …Talbot, T.R. (2013, Jan 13th). Reducing blood culture contamination in the emergency department: An interrupted time series quality improvement study. Academic Emergency Medicine, 20(1), pp. 89-97. doi: 10.111/acem.12057
I was interested in your presentation because my facility also had this same issue. Our facility’s answer was to only allow phlebotomist to draw blood cultures. It’s great because it’s targeted to a limited amount of people, so training can be applied specifically to them. If blood culture contamination is still an issue, it’s easier to know where the fail is located. The downside of this is clearly that it often causes for more patient sticks. You have to weigh your pros and cons, risk more contaminated blood cultures causing increased patient stays and cost or inconvenience the patient for another stick. It would just be culturally evaluated I’m sure. In your scenario, having only one phlebotomist available would make this more difficult, but if you said they had to be present with every draw anyhow, then they should just be the ones doing it. It could then free up your ED staff for other needs. Would there be another reason this wouldn’t work? I suppose if you are drawing with IV access, this would be unrealistic. That is where the additional stick comes in. However, if you’re waiting for their presence to start an IV for the draw, then it could be delaying patient care. There is just a lot to consider and evaluate. I wonder in your current facility the amount of contaminated blood draws that occurred from nurses/technician draws versus phlebotomist draws. There could be a trend to target if they were able to collect that data. I think the checklist is a wise idea though. It’d be a good reminder and then become habit of the required blood culture steps. One article I viewed, that I think you also referenced, likewise used a procedural checklist that was included with a blood culture drawing kit. It had sterile supplies of sterile gloves, skin prep, drape and needle (Self et al., 2013). I thought that was a wise idea. Their trial period seen a decrease from 4.3% to 1.7% with that intervention (Self et al., 2013). It would be more costly to include the kit though, but could be worth it. I’m really curious to see how your implementation comes out. Good luck! Sorry for such a long response, it just really got my brain ticking. Great topic choice.
Reference
Self, W.H., Speroff, T., Grijalva, C.G., McNaughton, C.D., Ashburn, J., Liu, D., …Talbot, T.R. (2013, Jan 13th). Reducing blood culture contamination in the emergency department: An interrupted time series quality improvement study. Academic Emergency Medicine, 20(1), pp. 89-97. doi: 10.111/acem.12057