Factors associated with blood culture sampling for adult acute care hospital patients with suspected severe infection: a scoping review using a socioecological framework

Abstract

Background: Reliable blood culture sampling for patients with suspected severe infection is critical, but evidence suggests that blood culture samples are not always reliably collected for acute hospital patients with severe infection. There is a pressing need to understand the barriers and facilitators of optimal sampling practices for patient safety and antimicrobial stewardship.

Methods: We conducted a scoping review to identify evidence of factors associated with reliable blood culture sampling, for adult patients with suspected severe infection in acute care in high-income countries. We searched bibliographic databases (MEDLINE, Scopus, Web of Science, CINAHL), reference lists and citations between 2013 and February 2024. Findings were mapped to a socioecological framework.

Results: We retrieved 1823 records from the database searches; 7 studies were eligible for inclusion, with 8 additional studies identified from reference lists and citation searches. All 15 included papers identified factors at the individual level of influence, including patient factors (demographics, clinical signs and symptoms) and staff factors (knowledge of guidelines, attitudes and beliefs, emotion, clinical experience and training, and perception of economic cost). Evidence gaps existed in relation to factors at interpersonal, situational, organizational, community and policy levels.

Conclusions: Our review provides insights into blood culture sampling practices in hospitals, and highlights possible evidence gaps as potential areas to guide future research and inform the development of interventions to improve blood culture sampling in hospitals. Existing research has been dominated by a focus on individual levels of influence, with a paucity of evidence on influences at the interpersonal, situational, organization, community and policy levels.

Figure 1.

A socioecological framework of factors associated with reliable blood culture sampling for adult acute care patients with suspected severe infection.