Implementation of the Theory of Planned Behavior to Promote Compliance with a Chlorhexidine Gluconate Protocol

2017 ◽  
Vol 22 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Christina Ryan
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Theory Of Planned Behavior ◽  
Medical Treatment ◽  
Patient Care ◽  
Planned Behavior ◽  
False Positive ◽  
Chlorhexidine Gluconate ◽  
Blood Cultures

Abstract Introduction: Blood cultures are critical values for identifying the source of an infection in patients seeking medical treatment for an acute illness. False-positive cultures can negatively influence patient care when physicians use inaccurate information to prescribe treatment. Inaccurate prescribed treatment negatively influences the quality of patient care related to prolonged medical treatment and hospital stay and unnecessary repetition of diagnostic tests. Purpose: The purpose of this project was to determine if blood culture contamination rates would be decreased if improved availability of CHG products was provided in all emergency department patient care areas would reduce the contamination rates of blood cultures. Methodology: The Theory of Planned Behavior provided the theoretical framework for this descriptive correlational project to examine barriers to following the procedural guidelines to cleanse venipuncture sites with a chlorhexidine gluconate (CHG) product before venipuncture Alcohol preparation pads were removed from the emergency department and a CHG product packaged similar to the alcohol preparation pads was placed in the department procedure trays and bedside carts. Results: During the first 2 weeks of the pilot project, blood culture contamination rates were reduced from 4.5% to 1.5%. The following month, rates remained low at 1.9%. Conclusion: Placement of CHG products at the bedside will improve patient safety and quality of care by reducing the incidence of inaccurate diagnosis and treatment based on false-positive blood cultures.

scholarly journals Blood Culture Contamination in a Community Hospital- less than 2% is achievable

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S127-S127
Author(s):  
R Bedi ◽  
J Atkinson
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Antimicrobial Therapy ◽  
False Positive ◽  
Community Hospital ◽  
Blood Cultures ◽  
Proper Order ◽  
Multiple Devices ◽  
American Society

Abstract Introduction/Objective Blood cultures are commonly obtained to evaluate the presence of bacteria or fungal infection in a patient’s bloodstream. The presence of living microorganisms circulating in the bloodstream is of substantial prognostic and diagnostic importance. A positive blood culture indicates a reason for the patient’s illness and provides the etiological agent for antimicrobial therapy. Collection of blood culture is an exact process that requires time, the proper order of draw, and following of correct protocol. The busy Emergency department that requires multiple demands for nurse’s time, turnover of staff, rushing from one task to another can result in the improper collection and false-positive blood cultures. The national benchmark is set at 3% by the American Society of Clinical Microbiology (ASM) and The Clinical and Laboratory Standard Institute (CLSI). False-positive blood culture results in increased length of stay and unnecessary antimicrobial therapy, resulting in an increased cost burden to the hospital of about $5000 per patient. Methods/Case Report At our 150-bed community hospital, 26 beds Emergency Department, we have come a long way in reduction of our blood culture contamination rates from upwards of 4% to less than 2%, far lower than the national benchmark. Results (if a Case Study enter NA) NA Conclusion There are multiple devices available from various manufacturers claiming to reduce blood culture contamination. These devices do reduce blood culture (BC) contamination but at an added cost of the device. The rate of BC can be reduced and less than 3% is achievable by materials available in the laboratory. We have achieved this by providing training to every new staff by demonstration and direct observation, providing everything required for collection in a kit, using proper technique, the inclusion of diversion method that involves the aseptic collection of a clear tube before collecting blood cultures, and following up monthly on any false positive blood cultures.

scholarly journals LO47: Use of C-reactive protein can safely decrease the number of emergency department patients with sepsis who require blood cultures

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S44
Author(s):  
R. Stenstrom ◽  
J. Choi ◽  
E. Grafstein ◽  
T. Kawano ◽  
D. Sweet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
False Positive ◽  
Blood Cultures ◽  
Low Risk ◽  
Reactive Protein ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Introduction: Sepsis protocols call for the acquisition of blood cultures in septic emergency department (ED) patients.However, the criteria for blood cultures are vague, they are costly, only positive 8-12% of the time, with up to half of these being false positives. The objective of this study was to establish if positive blood cultures could be excluded in low-risk sepsis patients with levels of CRP below 20 ml/L. Methods: This was a multicenter prospective cohort study of 765 ED patients at St Paul’s and Mount St Joseph’s hospitals in Vancouver with sepsis (2 or more SIRS criteria and infection) and none of: immuncompromised, injection drug use, indwelling vascular device or septic shock (SBP<90 mmhg). Consecutive patients with sepsis had CRP and blood cultures obtained at the same time.OUTCOMES. True positive blood cultures, false positive blood cultures, positive blood cultures that changed patient management. True and false positive blood cultures were based on Infectious Disease Society of America Guidelines, and change in management was defined as change in type or length of antibiotic therapy and was blindly adjudicated by a medical microbiologist. Results: 765 ED patients with sepsis met inclusion criteria. Mean age was 48.3 years and 57% were male. Blood cultures were positive in 99/765 (12.9%) subjects, of which 19 were false positive (19.2%). CRP was >20 mg/L in 595/765 (77.8%) of patients. Of 170 subjects with a CRP<20 mg/L, 3 had a positive blood culture (1.8%; 95% CI 0.1%- 5%). Management was not changed in any patient with a positive blood culture and CRP level<20 mg/L. Of 19 subjects with a false positive blood culture, CRP was <20 mg/L for 6 (31.6%). Conclusion: In this cohort of low-risk sepsis patients, based on a CRP of <20 mg/L, acquisition of blood cultures could be safely avoided in 22.2% of patients, at significant savings to the health care system.

scholarly journals Implementation of satellite blood-culture system in an emergency department: impact of time-to results in sepsis detection

2016 ◽  
Vol 31 (2) ◽  
Author(s):  
Andrea Rocchetti ◽  
Fabio Rapallo ◽  
Paolo Bottino ◽  
Alessandra Mastrazzo
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Culture System ◽  
Turnaround Time ◽  
Blood Cultures ◽  
Blood Culture System ◽  
Hospital Units ◽  
The Times ◽  
Sepsis Detection

The aim of this study is to compare the time differences in the detection of sepsis, making a comparison between the TAT (turnaround time) of blood cultures in the Emergency Department (ED) compared to the other hospital units. Positive blood cultures were divided into 2 groups: those from ED, and those from other hospital units. For this reason, a continuously monitoring blood culture incubator has been placed in the ED. We considered only adult patients. During the 1-year study, we considered all positive for each patient. Results obtained demonstrate that placing an automated blood culture system in an area of critical importance allows to obtain significant improvements in terms of time and quality of the results. Furthermore, reduction of TAT is determined more by the times of sample transport rather than the processing time.

Assessing Preschoolers’ Beverage Consumption Using the Theory of Planned Behavior

2017 ◽  
Vol 57 (6) ◽  
pp. 711-721
Author(s):  
Cherry Choy ◽  
Inyang A. Isong
Keyword(s):  
Theory Of Planned Behavior ◽  
Planned Behavior ◽  
Behavioral Intention ◽  
Self Efficacy ◽  
Parental Attitudes ◽  
Future Health ◽  
Sugar Sweetened Beverage ◽  
Beverage Consumption ◽  
Self Image

Childhood obesity and caries are linked to sugar-sweetened beverage (SSB) and excessive juice consumption. We assessed psychosocial factors influencing children’s beverage consumption and strategies to promote healthier choices. Using a quantitative and qualitative approach guided by the theory of planned behavior, we surveyed and interviewed 37 parents of preschool-aged children on barriers and facilitators of children’s beverage consumption. Most children (83.8%) consumed SSBs, 67.6% drank >4 to 6 oz of juice per day. Parent’s self-efficacy was the strongest correlate of parent’s behavioral intention to limit SSB (0.72, standard error 0.08, P = .03). Parents’ motivations to limit their child’s SSB intake extended beyond simply preventing caries and obesity; they also considered the implications of these conditions on children’s self-image, future health, and quality of life. Yet, the influence of multidimensional barriers made it difficult to reduce children’s SSB consumption. Interventions that address parental attitudes, values, and self-efficacy to address external factors could help reduce children’s SSB consumption.

scholarly journals 118. Eliminating Blood Culture Contamination with an Initial-specimen Diversion Device

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S187-S187
Author(s):  
Lucy S Tompkins ◽  
Alexandra Madison ◽  
Tammy Schaffner ◽  
Jenny Tran ◽  
Pablito Ang
Keyword(s):  
Health Care ◽  
Blood Culture ◽  
Nursing Staff ◽  
False Positive ◽  
Blood Cultures ◽  
Traditional Methods ◽  
Standard Methods ◽  
Candida Sp ◽  
Initial Specimen ◽  
Skin Flora

Abstract Background Blood samples obtained via traditional venipuncture can become contaminated by superficial and deeply embedded skin flora. We evaluated the hospital-wide use of an initial-specimen diversion device (ISDD) designed to shunt these microorganisms away from the culture bottle to reduce blood culture contamination (BCC) and sequelae: false-positive central line-associated bloodstream infections (CLABSIs), repeat blood culture draws, inappropriate antibiotic usage, increased patient length-of-stay and misdiagnosis. The study aimed to show the proportion of blood cultures containing contaminants drawn by phlebotomy staff using the ISDD versus those drawn using traditional methods. Nursing staff continued to use traditional methods to draw blood cultures in the emergency department (ED) and from inpatients. Methods Over a four-month trial at Stanford Health Care (SHC), 4,462 blood cultures were drawn by phlebotomy staff using the ISDD (Steripath Gen2, Magnolia Medical Technologies) in the ED and from inpatients; 922 blood cultures were obtained by phlebotomy staff using standard methods. Additionally, 1,413 blood cultures were drawn by nursing staff using standard methods. The number of matched sets (2 bottles [aerobic/anaerobic] plus 2 bottles [aerobic/anaerobic], with total volume 40 ml) obtained through traditional methods and by the ISDD were recorded. Contaminants were defined by the National Healthcare Safety Network (NHSN). In addition, sets in which 1 out of 4 bottles contained vancomycin-resistant Enterococcus (VRE) or Candida sp. were also recorded, even though these are not considered contaminants by the NHSN. Results Of 4,462 blood cultures obtained using the ISDD there were zero contaminants found (BCC rate 0%) versus 29 contaminated sets using traditional methods (BCC rate 3.15%). Twenty-eight contaminants were observed from nursing staff blood culture draws (BCC rate 1.98%). Zero false-positive CLABSIs were associated with use of the ISDD for the trial period. No matched sets containing 1 of 4 bottles with VRE or Candida sp. were observed. Table Stanford Health Care blood culture collection methods and contamination events (March 15, 2019 - July 21, 2019) Conclusion The trial results encourage adoption of the ISDD as standard practice for blood culture at SHC. Disclosures All Authors: No reported disclosures

scholarly journals A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

2018 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Linze F. Hamilton ◽  
Helen E. Gillett ◽  
Adam Smith-Collins ◽  
Jonathan W. Davis
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
False Positive ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Group Versus ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Blood Cultures ◽  
Before And After

Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

scholarly journals Neither Blood Culture Positivity nor Time to Positivity is Associated with Mortality among Patients Presenting with Severe Manifestations of Sepsis: The FABLED Cohort Study

2021 ◽  
Author(s):  
Katryn Paquette ◽  
David Sweet ◽  
Robert Stenstrom ◽  
Sarah N Stabler ◽  
Alexander Lawandi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Blood Culture ◽  
Blood Cultures ◽  
Cell Counts ◽  
Culture Positivity ◽  
Time To Positivity ◽  
Blood Culture Positivity ◽  
Normal White Blood Cell ◽  
Support Fund

Abstract Background Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide. Methods We conducted a multi-center, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis (ClinicalTrials.gov: NCT01867905). Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality. Findings 325 participants were enrolled; 90-day mortality among the 315 subjects followed-up was 25·4% (80/315). Mortality was associated with age (mean age in those who died was 72·5 ±15·8 vs. 62·9 ±17·7 years among survivors, p&lt;0·0001), greater Charlson Comorbidity Index (2 (IQR 1,3) vs. 1 (IQR 0,3), p=0·008), dementia (13/80 (16·2%) vs. 18/235 (7·7%), p=0·03), cancer (27/80 (33·8%) vs. 47/235 (20·0%), p=0·015), positive qSOFA score (57/80 (71·2%) vs. 129/235 (54·9%), p=0·009), and normal white blood cell counts (25/80 (31·2%) vs. 42/235 (17·9%), p=0·02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality. Interpretation Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity. Funding Vancouver Coastal Health; St-Paul’s Hospital Foundation Emergency Department Support Fund; the Fonds de Recherche Santé – Québec (CPY); Intramural Research Program of the NIH, Clinical Center (AL); the Maricopa Medical Foundation

Unscheduled Revisits after Diagnosis of Abdominal Pain at Emergency Department, Mukdahan Hospital

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S40-S43
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Patient Care ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Discharge System ◽  
Effective Discharge ◽  
Time Period ◽  
Pain Patients

Background: Abdominal pain is a common complaint for patients revisiting the Emergency Department (ED). Evaluating the cause of the revisit can improve the quality of ED patient care. Objective: We aimed to analyzed unscheduled revisits after diagnosis of abdominal pain at emergency department. Materials and Methods: In order to determine the characteristics of their abdominal pain and the causes for the revisits, the charts of 90 patients were reviewed. These patients had experienced acute abdominal pain and had returned to the Emergency Department within 48 hours after their initial treatment during the period between January 2019 and December 2019. Results: During that time period, 44,000 patients visited the ED. Of these, 90 patients (0.2%) with acute abdominal pain or related symptoms had revisited the ED within the following 48 hours. Most of these patients had been 20 to 60 years of age and had had no co-morbid diseases. Almost half of patient revisits had occurred during the evening shift (45.6%). There were 74% of these patients, who had been admitted to hospital for observation or for procedures. No in-hospital mortality was reported for this study. The signs and symptoms of abdominal pain in these patients had not been specific. The factors, which most often contributed to the ED revisits, had been inappropriate consultations and inappropriate discharges or advises. Conclusion: The majority of the acute abdominal pain patients, who revisited the ED within 48 hours, had been admitted. The most common cause of revisits had been inappropriate consultations and inappropriate discharges. Improving ED patient care can be managed by contributing to effective consultations and to establishing an effective discharge system for the ED. Keywords: Revisits, Emergency medicine department, Acute abdominal pain

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

scholarly journals 660. Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S432-S432
Author(s):  
Alexander G Hosse
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Nursing Staff ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Contamination Rate ◽  
Culture Collections ◽  
Total Blood ◽  
Primary Driver ◽  
Inpatient Units

Abstract Background Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic. Methods Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units. Results The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units. Figure 1. Comparison of contamination rates in the ED vs the inpatient units from all campuses from September 2019 through September 2020. The blue line represents the hospital goal of 2.25% contamination rate. Solid lines represent total contamination rates including COVID isolation units whereas dotted lines represent units excluding COVID isolation units. Figure 2. Comparison of the non-COVID vs COVID isolation units in the emergency department and inpatient units. The red line represents the hospital goal of less than 2.25% for blood culture contamination rate. Table of Contaminants vs. Total Collected Blood Cultures in Each Unit by Month Figure 3. Raw data from Figure 2. Total blood culture contaminations from each unit by month compared to total blood culture collections from each unit by month. Conclusion Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during. Disclosures All Authors: No reported disclosures

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