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Meta-Analysis
. 2012 Sep;45(13-14):999-1011.
doi: 10.1016/j.clinbiochem.2012.06.007. Epub 2012 Jun 16.

Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis

Susan R Snyder  1 , Alessandra M Favoretto, Rich Ann Baetz, James H Derzon, Bereneice M Madison, Diana Mass, Colleen S Shaw, Christopher D Layfield, Robert H Christenson, Edward B Liebow
Affiliations
Meta-Analysis

Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis

Susan R Snyder et al. Clin Biochem. 2012 Sep.

Abstract

Objectives: This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits.

Design and methods: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used.

Results: Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12).

Conclusions: Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement.

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Figures

Fig. 1
Fig. 1
LMBP QI analytic framework: blood culture contamination.
Fig. 2
Fig. 2
Systematic review flow diagram.
Fig. 3
Fig. 3
Meta-analysis forest plot: venipuncture versus catheter collection.
Fig. 4
Fig. 4
Meta-analysis forest plot: phlebotomy teams.
Fig. 5
Fig. 5
Meta-analysis forest plot: prepackaged prep kits.
See this image and copyright information in PMC

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Appendix B. LMBP blood culture contamination systematic review eligible studies

Venipuncture vs. intravenous catheter collection
Included studies
Published
    1. Beutz M, Sherman G, Mayfield J, Fraser VJ, Kollef MH. Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients. Chest. 2003;123:854–61. - PubMed
    1. DesJardin JA, Falagas ME, Ruthazer R, Griffith J, Wawrose D, Schenkein D, et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Annals of Internal Medicine. 1999;131:641–7. - PubMed
    1. Everts RJ, Vinson EN, Adholla PO, Reller LB. Contamination of catheter-drawn blood cultures. Journal of Clinical Microbiology. 2001;39:3393–4. - PMC - PubMed
    1. Martinez JA, DesJardin JA, Aronoff M, Supran S, Nasraway SA, Snydman DR. Clinical utility of blood cultures drawn from central venous or arterial catheters in critically ill surgical patients. Critical Care Medicine. 2002;30:7–13. - PubMed
    1. McBryde ES, Tilse M, McCormack J. Comparison of contamination rates of catheter-drawn and peripheral blood cultures. The Journal of Hospital Infection. 2005;60:118–21. - PubMed
Excluded studies
Published
    1. Gonsalves WI, Cornish N, Moore M, Chen A, Varman M. Effects of volume and site of blood draw on blood culture results. Journal of Clinical Microbiology. 2009;47:3482–5. - PMC - PubMed
Phlebotomy teams
Included studies
Published
    1. 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. Journal of Clinical Microbiology. 2009;47:1021–4. - PMC - PubMed
    1. Sheppard C, Franks N, Nolte F, Fantz C. Improving quality of patient care in an emergency department: a laboratory perspective. American Journal of Clinical Pathology. 2008;130:573–7. - PubMed
    1. Surdulescu S, Utamsingh D, Shekar R. Phlebotomy teams reduce blood-culture contamination rate and save money. Clinical Performance and Quality Health Care. 1998;6:60–2. - PubMed
    1. 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. Journal of Clinical Microbiology. 1997;35:563–5. - PMC - PubMed
Unpublished

    1. Geisinger Wyoming Valley Hospital; 2009.

Excluded
Unpublished

    1. Providence Regional Medical Center Everett, WA 2009

Prepackaged prep kit
Included studies
Published
    1. McLellan E, Townsend R, Parsons HK. Evaluation of chloraprep (2% chlorhexidine gluconate in 70% isopropyl alcohol) for skin antisepsis in preparation for blood culture collection. The Journal of Infection. 2008;57:459–63. - PubMed
    1. 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. Infection Control and Hospital Epidemiology: the Official Journal of the Society of Hospital Epidemiologists of America. 2002;23:397–401. - PubMed
    1. 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. Journal of Clinical Microbiology. 1997;35:563–5. - PMC - PubMed
    1. Wilson ML, Weinstein MP, Mirrett S, Reimer LG, Fernando C, Meredith FT, et al. Comparison of iodophor and alcohol pledgets with the medi-flex blood culture prep kit II for preventing contamination of blood cultures. Journal of Clinical Microbiology. 2000;38:4665–7. - PMC - PubMed
Excluded studies
Published
    1. Madeo M, Davies D, Owen L, Wadsworth P, Johnson G, Martin CR. Reduction in the contamination rate of blood cultures collected by medical staff in the accident and emergency department. Clinical Effectiveness in Nursing. 2003;7:30–2.

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