Improvement of blood culture contamination rate, blood volume, and true positive rate after introducing a dedicated phlebotomy team
- 285 Downloads
The introduction of dedicated phlebotomy teams certified for blood collection has been reported to be highly cost-effective by reducing contamination rates. However, data on their effects on blood volume and true positive rate are limited. Therefore, we investigated the effect of replacing interns with a phlebotomy team on blood culture results. We performed a 24-month retrospective, quasi-experimental study before and after the introduction of a phlebotomy team dedicated to collecting blood cultures in a 2700-bed tertiary-care hospital. The microbiology laboratory database was used to identify adult patients with positive blood culture results. During the study period, there were no changes in blood collection method, blood culture tubes, and the application of antiseptic measures. Blood volume was measured by the BACTEC™ FX system based on red blood cell metabolism. A total of 162,207 blood cultures from 23,563 patients were analyzed, comprising 78,673 blood cultures during the intern period and 83,534 during the phlebotomy team period. Blood volume increased from a mean of 2.1 ml in the intern period to a mean of 5.6 ml in the phlebotomy team period (p < 0.001). Introduction of the phlebotomy team also reduced contamination rate (0.27% vs. 0.45%, p < 0.001) and led to a higher true positive rate (5.87% vs. 5.01%, p < 0.05). The increased true positive rate associated with the phlebotomy team involved both gram-positive and gram-negative bacteria. The introduction of a dedicated phlebotomy team can increase blood volumes, reduce blood culture contamination rate, and increase true positive rate.
KeywordsPhlebotomy team Blood volume Blood culture Contamination rate True positive rate
This work was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health and Welfare, Republic of Korea (grant number HI12C0756). The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study formal consent is not required.
- 2.Souvenir D, Anderson DE Jr, Palpant S, Mroch H, Askin S, Anderson J, Claridge J, Eiland J, Malone C, Garrison MW, Watson P, Campbell DM (1998) Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 36(7):1923–1926Google Scholar
- 6.Weinbaum FI, Lavie S, Danek M, Sixsmith D, Heinrich GF, Mills SS (1997) Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 35(3):563–565Google Scholar
- 9.Tenney JH, Reller LB, Mirrett S, Wang WL, Weinstein MP (1982) Controlled evaluation of the volume of blood cultured in detection of bacteremia and fungemia. J Clin Microbiol 15(4):558–561Google Scholar
- 11.Li J, Plorde JJ, Carlson LG (1994) Effects of volume and periodicity on blood cultures. J Clin Microbiol 32(11):2829–2831Google Scholar
- 12.Willems E, Smismans A, Cartuyvels R, Coppens G, Van Vaerenbergh K, Van den Abeele AM, Frans J, Bilulu Study G (2012) The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 73(1):1–8CrossRefGoogle Scholar
- 14.Clinical and Laboratory Standards Institue (2007) Principles and procedures for blood cultures; approved guideline. CLSI document M47-A. Clinical and Laboratory Standards Institute, WayneGoogle Scholar
- 15.Garcia RA, Spitzer ED, Beaudry J, Beck C, Diblasi R, Gilleeny-Blabac M, Haugaard C, Heuschneider S, Kranz BP, McLean K, Morales KL, Owens S, Paciella ME, Torregrosa E (2015) Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control 43(11):1222–1237CrossRefGoogle Scholar
- 22.Bekeris LG, Tworek JA, Walsh MK, Valenstein PN (2005) Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 129(10):1222–1225Google Scholar
- 24.Gilligan PH, York MK (2016) General detection and interpretation. In: Leber AL (ed) Clinical microbiology procedures handbook, 4th edn. American Society of Microbiology, Washington, DC, pp 121–151Google Scholar