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Cost Analysis of Strategies to Reduce Blood Culture Contamination in the Emergency Department: Sterile Collection Kits and Phlebotomy Teams

Published online by Cambridge University Press:  10 May 2016

Wesley H. Self ,
Thomas R. Talbot ,
Barbara R. Paul ,
Sean P. Collins  and
Michael J. Ward
Wesley H. Self*
Affiliation:
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Department of Medicine and Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Barbara R. Paul
Affiliation:
Community Health Systems Professional Services, Franklin, Tennessee
Sean P. Collins
Affiliation:
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Michael J. Ward
Affiliation:
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
*
1313 21st Avenue South, 703 Oxford House, Vanderbilt University Medical Center, Nashville, TN 37232 ([email protected]).
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Extract

Objective

Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams.

Design

Cost analysis.

Setting

This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually.

Methods

Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated).

Results

Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses.

Conclusions

EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 1021 - 1028
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584–602.Google Scholar
2. Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788–802.Google Scholar
3. Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365–369.Google Scholar
4. 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;107:119–125.Google Scholar
5. Zwang, O, Albert, RK. Analysis of strategies to improve cost effectiveness of blood cultures. J Hosp Med 2006;1:272–276.Google Scholar
6. Gander, RM, Byrd, L, DeCrescenzo, M, Hirany, S, Bowen, M, Baughman, J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 2009;47:1021–1024.Google Scholar
7. Souvenir, D, Anderson, DE, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microb 1998;36:1923–1926.Google Scholar
8. van der Heijden, YF, Miller, G, Wright, PW, Shepherd, BE, Daniels, TL, Talbot, TR. Clinical impact of blood cultures contaminated with coagulase-negative staphylococci at an academic medical center. Infect Control Hosp Epidemiol 2011;32:623–625.Google Scholar
9. Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for Blood Cultures; Approved Guideline. Wayne, PA: CLSI, 2007. CLSI document M47-A.Google Scholar
10. Self, WH, Speroff, T, Grijalva, CG, et al. Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Acad Emerg Med 2013;20:89–97.Google Scholar
11. Self, WH, Mickanin, J, Grijalva, CG, et al. Reducing blood culture contamination in community hospital emergency departments: multicenter evaluation of a quality improvement intervention. Acad Emerg Med 2014;21:274–282.Google Scholar
12. Qamruddin, A, Khanna, N, Orr, D. Peripheral blood culture contamination in adults and venepuncture technique: prospective cohort study. J Clin Pathol 2008;61:509–513.Google Scholar
13. Archibald, LK. Pallangyo, K, Kazembe, P, Reller, LB. Blood culture contamination in Tanzania, Malawi and the United States: a microbiological tale of three cities. J Clin Microb 2006;44:4425–4429.Google Scholar
14. Madeo, M, Jackson, T, Williams, C. Simple measures to reduce the rate of contamination of blood cultures in accident and emergency. Emer Med J 2005;22:810–811.Google Scholar
15. Bamber, AI, Cunniffe, JG, Nayar, D, Ganguly, R, Falconer, E. Effectiveness of introducing blood culture collection packs to reduce contamination rates. Br J Biomed Sci 2009;66:6–9.Google Scholar
16. Sheppard, C, Franks, N, Nolte, F, Fantz, C. Improving quality of patient care in an emergency department: a laboratory perspective. Am J Clin Path 2008;130:573–577.Google Scholar
17. 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;35:563–565.Google Scholar
18. Lee, A, Joynt, GM, Ho, AM, Keitz, S, McGinn, T, Wyer, PC. Tips for teachers of evidence-based medicine: making sense of decision analysis using a decision tree. J Gen Intern Med 2009;24:642–648.Google Scholar
19. Hunink, M, Glasziou, P, Siegel, J, et al. Decision Making in Health and Medicine: Integrating Evidence and Values. Cambridge: Cambridge University Press, 2001.Google Scholar
20. Self, WH, Speroff, T, McNaughton, CD, et al. Blood culture collection through peripheral intravenous catheters increases the risk of specimen contamination among adult emergency department patients. Infect Control Hosp Epidemiol 2012;33:524–526.Google Scholar
21. TreeAge Software 2013. Williamstown, MA. http://www.treeage.com.Google Scholar
22. Weinstein, MP, Reller, LB, Murphy, JR, Lichtenstein, KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 1983;5:35–53.Google Scholar
23. Bekeris, LG, Tworek, JA, Walsh, MK, Valenstein, PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005;129:1222–1225.Google Scholar
24. Muennig, P. Cost Effectiveness Analysis in Healthcare: A Practical Approach. 2nd ed. San Francisco, CA: Wiley, 2008.Google Scholar
25. US Bureau of Labor Statistics. CPI Inflation Calculator. http://data.bls.gov/cgi-bin/cpicalc.pl. Accessed August 23, 2013.Google Scholar
26. Shapiro, NI, Wolfe, RE, Wright, SB, Moore, R, Bates, DW. Who needs a blood culture? a prospectively derived and validated prediction rule. J Emerg Med 2008;35:255–264.Google Scholar