Evidence Based Practice
Collection of Blood Cultures
Tracy
Evidence Based Practice for The Baccalaureate Prepared Nurse
Abstract Proper collection of blood cultures are necessary and the most direct method of determining whether or not a patient is septic. The purpose of obtaining blood cultures is to identify and isolate the bacteria that are causing an illness and then determine the best course of treatment based on the sensitivity of the bacteria to particular antibiotics. One of the most frustrating problems plaguing hospitals is the increased rate at which blood culture results are being returned as contaminated specimens. These results can lead to a significant increase in cost to the hospital and patient as well as an increased length in hospital stay and the administration of unnecessary antibiotics. The Center for Medicare Services (CMS) has recently implemented a core measure for Community Acquired Pneumonia (CAP). This new guideline states that blood cultures are to be obtained prior to the administration of antibiotics for all patients suspected of or diagnosed with CAP. Furthermore, this requirement states that the first antibiotic is to be administered to the patient within six hours of arrival to the hospital. This means in order to meet this requirement more and more blood cultures are being obtained in the emergency department by emergency room personnel, thus leading to the PICOT question; In patients presenting to the emergency room, how does contamination of blood cultures obtained by nurses compared to proper collection of blood cultures obtained by nurses, affect administration of unnecessary antibiotics and increased length of stay. Although it is impossible to completely eliminate the contamination of blood cultures a review of the literature and studies will show that the rate of contamination can be greatly reduced by implementing a training and education program to all staff that obtain blood cultures.
Review of the Literature In order to implement
Tracy
Evidence Based Practice for The Baccalaureate Prepared Nurse
Abstract Proper collection of blood cultures are necessary and the most direct method of determining whether or not a patient is septic. The purpose of obtaining blood cultures is to identify and isolate the bacteria that are causing an illness and then determine the best course of treatment based on the sensitivity of the bacteria to particular antibiotics. One of the most frustrating problems plaguing hospitals is the increased rate at which blood culture results are being returned as contaminated specimens. These results can lead to a significant increase in cost to the hospital and patient as well as an increased length in hospital stay and the administration of unnecessary antibiotics. The Center for Medicare Services (CMS) has recently implemented a core measure for Community Acquired Pneumonia (CAP). This new guideline states that blood cultures are to be obtained prior to the administration of antibiotics for all patients suspected of or diagnosed with CAP. Furthermore, this requirement states that the first antibiotic is to be administered to the patient within six hours of arrival to the hospital. This means in order to meet this requirement more and more blood cultures are being obtained in the emergency department by emergency room personnel, thus leading to the PICOT question; In patients presenting to the emergency room, how does contamination of blood cultures obtained by nurses compared to proper collection of blood cultures obtained by nurses, affect administration of unnecessary antibiotics and increased length of stay. Although it is impossible to completely eliminate the contamination of blood cultures a review of the literature and studies will show that the rate of contamination can be greatly reduced by implementing a training and education program to all staff that obtain blood cultures.
Review of the Literature In order to implement
References: Alahmadi, Y., Aldeyab, M., McElnay, J., Scott, M., Darwish Elhajji, F., Magee, M, Dowds, M., Edwards, C., Fullerton, L., Tate, A, Kearney, M. (2011) Clinical and economic impact of contaminated blood cultures within the hospital setting. Journal of Hospital Infection 77, 232-236. doi: 10.1016/j.jhin.2010.09.033. Gander, R., Byrd, L., DeCrescenzo, Hirany, S., Bowen, M., Baughman, J. (2009) Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. Journal of Clinical Microbiology 47(4), 1021-1024. doi: 10.1128/jcm.02162-08. Robert, R. (2011) Reducing blood cultures contamination through an education program. Journal of Infusion Nursing 34 (1): 49-54. Retrieved February 6, 2013 from: www.cinahl.com. Self, W. H., Speroff, T., McNaughton, C. D., Wright, P. W., Miller, G, Johnson, J. G., & Talbot, T. R. (2012). Blood cultures collection through peripheral intravenous catheters increases the risk of specimen contamination among adult emergency department patients. Infection Control & hospital Epidemiology, 33(5), 524-526. doi: 10.1086/665319