Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-28T18:21:57.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Blood Culture Contamination: A Randomized Trial Evaluating the Comparative Effectiveness of 3 Skin Antiseptic Interventions

Published online by Cambridge University Press:  02 January 2015

Laraine L. Washer ,
Carol Chenoweth ,
Hae-Won Kim ,
Mary A. M. Rogers ,
Anurag N. Malani ,
James Riddell IV ,
Latoya Kuhn ,
Bernard Noeyack Jr ,
Harry Neusius  and
Duane W. Newton
...Show all authors
Laraine L. Washer*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Carol Chenoweth
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Hae-Won Kim
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
Mary A. M. Rogers
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
Anurag N. Malani
Affiliation:
Saint Joseph Mercy Hospital, Ann Arbor, Michigan
James Riddell IV
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Latoya Kuhn
Affiliation:
Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Bernard Noeyack Jr
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Harry Neusius
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Duane W. Newton
Affiliation:
Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan
*
Division of Infectious Diseases, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine relative rates of blood culture contamination for 3 skin antisepsis interventions—10% povidone iodine aqueous solution (PI), 2% iodine tincture (IT), and 2% chlorhexidine gluconate in 70% isopropyl alcohol (CHG)—when used by dedicated phlebotomy teams to obtain peripheral blood cultures.

Design.

Randomized crossover trial with hospital floor as the unit of randomization.

Setting.

Teaching hospital with 885 beds.

Patients.

All adult patients undergoing peripheral blood culture collection on 3 medical-surgical floors from May 2009 through September 2009.

Intervention.

Each antisepsis intervention was used for 5 months on each study floor, with random crossover after a 1-month washout period. Phlebotomy teams collected all peripheral blood cultures. Each positive blood culture was adjudicated by physicians blinded to the intervention and scored as a true positive or contaminated blood culture. The primary outcome was the rate of blood culture contamination for each antisepsis agent.

Results.

In total, 12,904 peripheral blood culture sets were evaluated, of which 735 (5.7%) were positive. There were 98 contaminated cultures, representing 13.3% of all positive cultures. The overall blood culture contamination rate for the study population was 0.76%. Intent-to-treat rates of contaminated blood cultures were not significantly different among the 3 antiseptics (P = .18), yielding 0.58% with PI (95% confidence interval [CI], 0.38%-0.86%), 0.76% with IT (95% CI, 0.52%-1.07%), and 0.93% with CHG (95% CI, 0.67%-1.27%).

Conclusion.

Choice of antiseptic agent does not impact contamination rates when blood cultures are obtained by a phlebotomy team and should, therefore, be based on costs or preference.

Trial Registration.

ClinicalTrials.gov identifier: NCT01216761.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 15 - 21
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Schifman, RB, Strand, CL, Meier, FA, Howanitz, PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497 134 specimens from adult patients. Arch Pathol Lab Med 1998;122(3):216–221.Google Scholar
2. Strand, CL, Wajsbort, RR, Sturmann, K. Effect of iodophor vs iodine tincture skin preparation on blood culture contamination rate. JAMA 1993;269(8):1004–1006.10.1001/jama.1993.03500080052031Google Scholar
3. Little, JR, Trovillion, E, Fraser, V. High frequency of pseudobacteremia at a university hospital. Infect Control Hosp Epidemiol 1997;18(3):200–202.10.2307/30141983Google Scholar
4. Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265(3):365–369.10.1001/jama.1991.03460030071031Google Scholar
5. Souvenir, D, Anderson, DE Jr, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998; 36(7):1923–1926.10.1128/JCM.36.7.1923-1926.1998Google Scholar
6. Zwang, O, Albert, RK. Analysis of strategies to improve cost effectiveness of blood cultures. J Hosp Med 2006;1(5):272–276.10.1002/jhm.115Google Scholar
7. Weinbaum, FI, Lavie, S, Danek, M, Sixsmith, D, Heinrich, GF, Mills, SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 1997;35(3):563–565.10.1128/JCM.35.3.563-565.1997Google Scholar
8. Kim, N, Kim, M, Lee, S, et al. Effect of routine sterile gloving on contamination rates in blood culture. Ann Intern Med 2011; 154(3):145–151.Google Scholar
9. Malani, A, Trimble, K, Parekh, V, Chenoweth, C, Kaufman, S, Saint, S. Review of clinical trials of skin antiseptic agents used to reduce blood culture contamination. Infect Control Hosp Epidemiol 2007;28(7):892–895.10.1086/518456Google Scholar
10. Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for Blood Cultures; Approved Guideline. Wayne, PA: CLSI, 2007. CLSI document M47-A.Google Scholar
11. Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19(4):788–802.10.1128/CMR.00062-05Google Scholar
12. Baron, EJ, Weinstein, MP, Dunne, WM, Yagupsky, P, Welch, DF, Wilson, DW. Cumitech 1C: Blood Cultures IV. Washington, DC: ASM Press, 2005.Google Scholar
13. Clinical and Laboratory Standards Institute (CLSI). Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard-Sixth Edition. Wayne, PA: CLSI, 2007. CLSI document H3-A6.Google Scholar
14. Mirrett, S, Weinstein, MP, Reimer, LG, Wilson, ML, Relier, LB. Relevance of the number of positive bottles in determining clinical significance of coagulase-negative staphylococci in blood cultures. J Clin Microbiol 2001;39(9):3279–3281.10.1128/JCM.39.9.3279-3281.2001Google Scholar
15. Weinstein, MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996;23(1):40–46.10.1093/clinids/23.1.40Google Scholar
16. Mimoz, O, Karim, A, Mercat, A, et al. Chlorhexidine compared with povidone-iodine as skin preparation before blood culture: a randomized, controlled trial. Ann Intern Med 1999;131(11): 834–837.10.7326/0003-4819-131-11-199912070-00006Google Scholar
17. Little, JR, Murray, PR, Traynor, PS, Spitznagel, E. A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination. Am J Med 1999;107(2):119–125.10.1016/S0002-9343(99)00197-7Google Scholar
18. Maiwald, M, Widmer, AF, Rotter, ML. Chlorhexidine is not the main active ingredient in skin antiseptics that reduce blood cuiture contamination rates. Infect Control Hosp Epidemiol 2010; 31(10):1095–1096.10.1086/656561Google Scholar
19. Wilson, ML, Weinstein, MP, Mirrett, S, et al. Comparison of io-dophor and alcohol pledgets with the Medi-Flex Blood Culture Prep Kit II for preventing contamination of blood cultures. J Clin Microbiol 2000;38(12):4665–4667.10.1128/JCM.38.12.4665-4667.2000Google Scholar
20. Calfee, DP, Farr, BM. Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial. J Clin Microbiol 2002; 40(5):1660–1665.10.1128/JCM.40.5.1660-1665.2002Google Scholar
21. Suwanpimolkul, G, Pongkumpai, M, Suankratay, C. A randomized trial of 2% Chlorhexidine tincture compared with 10% aqueous povidone-iodine for venipuncture site disinfection: effects on blood culture contamination rates. J Infect 2008;56(5): 354–359.Google Scholar
22. Madeo, M, Barlow, G. Reducing blood-culture contamination rates by the use of a 2% Chlorhexidine solution applicator in acute admission units. J Hosp Infect 2008;69(3):307–309.10.1016/j.jhin.2008.03.009Google Scholar
23. Marlowe, L, Mistry, RD, Coffin, S, et al. Blood culture contamination rates after skin antisepsis with Chlorhexidine gluconate versus povidone-iodine in a pediatric emergency department. Infect Control Hosp Epidemiol 2010;31(2):171–176.10.1086/650201Google Scholar
24. Trautner, BW, Clarridge, JE, Darouiche, RO. Skin antisepsis kits containing alcohol and Chlorhexidine gluconate or tincture of iodine are associated with low rates of blood culture contamination. Infect Control Hosp Epidemiol 2002;23(7):397–401.10.1086/502073Google Scholar
25. Barenfanger, J, Drake, C, Lawhorn, J, Verhulst, SJ. Comparison of Chlorhexidine and tincture of iodine for skin antisepsis in preparation for blood sample collection. J Clin Microbiol 2004;42(5): 2216–2217.10.1128/JCM.42.5.2216-2217.2004Google Scholar