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 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.

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 LO30: Prevalence of pulmonary embolism among emergency department patients with syncope: a multicenter prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S17-S17 ◽  
Author(s):  
V. Thiruganasambandamoorthy ◽  
M. L.A. Sivilotti ◽  
B. H. Rowe ◽  
A. D. McRae ◽  
M. Mukarram ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
The United States ◽  
Pulmonary Angiogram ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort ◽  
D Dimer ◽  
Combined Data

Introduction: The prevalence of pulmonary embolism (PE) among patients with syncope is understudied. Based on a recent study with an exceptionally high PE prevalence, some advocate investigating all syncope patients for PE, including those with another clear cause for their syncope. We sought to evaluate the PE prevalence among emergency department (ED) patients with syncope. Methods: We combined data from two large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of investigations related to PE (i.e. D-dimer or ventilation-perfusion (VQ) scan, or computed tomography pulmonary angiogram (CTPA)), and 30-day adjudicated outcomes including diagnosis of PE, arrhythmia, myocardial infarction, serious hemorrhage and/or death. Results: Of the 9,091 patients (median age 66 years, 51.9% females, 39.1% hospitalized) with 30-day follow-up, 546 (6.0%) were investigated for PE: 278 (3.1%) had D-dimer, 39 (0.4%) had VQ and 347 (3.8%) patients had CTPA performed. 30-day outcomes included: 874 (9.6%) patients with any serious outcome; 0.9% deaths; and 818 (9.0%) patients with non-PE serious outcomes. Overall, 56 patients (prevalence 0.6%; 95% CI 0.5% 0.8%) were diagnosed with PE, including 8 (0.1%) of those admitted to hospital at the index presentation. Only 11 patients (0.1%) with a non-PE serious condition had a concomitant underlying PE identified. Conclusion: The prevalence of PE is very low among ED patients with syncope, including those hospitalized following syncope. While acknowledging syncope may be caused by an underlying PE, clinicians should be cautious against indiscriminate over-investigations for PE.

scholarly journals Blood Culture Collection through Peripheral Intravenous Catheters Increases the Risk of Specimen Contamination among Adult Emergency Department Patients

2012 ◽  
Vol 33 (5) ◽  
pp. 524-526 ◽  
Author(s):  
Wesley H. Self ◽  
Theodore Speroff ◽  
Candace D. McNaughton ◽  
Patty W. Wright ◽  
Geraldine Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Relative Risk ◽  
Blood Culture ◽  
Confidence Interval ◽  
Culture Collection ◽  
Blood Cultures ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Emergency Department Patients ◽  
Intravenous Catheters

Five hundred five blood cultures collected through a peripheral intravenous catheter (PIV) in an emergency department were matched to cultures obtained by dedicated venipuncture from the same patient within 10 minutes. The relative risk of contamination for cultures collected through PIVs compared with dedicated venipuncture was 1.83 (95% confidence interval, 1.08–3.11).

scholarly journals Higher Nursing Care Level is Associated with Higher Incidence of Blood Culture Contamination in the Emergency Department: A Case-Control Study

2021 ◽  
Author(s):  
Ayami Shigeno ◽  
Yosuke Homma ◽  
Taiga Matsumoto ◽  
Shun Tanaka ◽  
Ryuta Onodera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Nursing Care ◽  
Positive Blood Culture ◽  
Case Control Study ◽  
Case Control ◽  
Blood Cultures ◽  
Case Group ◽  
Care Level ◽  
Control Study

Abstract Background Blood culture is critical in treating infectious diseases, but contamination occurs in 0.6–12.5% of all samples. This leads to unnecessary intervention, inappropriate antibiotic use, and excess cost. Few studies have tackled patient factors, such as nursing care level, that could possibly affect contamination rates. Thus, this study aimed to explore the association between patients’ nursing care levels and blood culture contamination. Methods This is a single centered, retrospective, case-control study of adult patients whose blood culture specimens were taken in the emergency department between April 2018 and July 2019. The study was conducted in a 344-bed, urban, acute care community hospital in Chiba prefecture, Japan. We included patients aged 20 years and above, with two or more sets of blood cultures. The case group included patients with false positive blood culture results with contamination; the control group included patients with true positive or true negative blood culture results without contamination. We randomly selected two control patients per case. Patients’ age, sex, nursing care level, ambulance usage, housing status, Glasgow Coma Scale, and hospital arrival time were obtained from the patients’ medical charts. Results Of the 5,130 patients, 686 patients got positive blood culture results. Of the 686 patients, 35 patients were included in the case group, and 70 were randomly selected from the non-contaminated group and included in the control. In multivariate analysis, patients with contaminated blood cultures had a higher nursing care level (odds ratio: 5.24; 95% confidence interval: 1.47 to 18.70; P = 0.02). Conclusions A higher nursing care level is associated with a higher incidence of blood culture contamination in the emergency department. Careful and appropriate procedures are required for patients with a higher nursing care level.

scholarly journals Blood cultures: towards zero false positives

2009 ◽  
Vol 10 (1_suppl) ◽  
pp. S24-S26 ◽  
Author(s):  
Frankie Thompson ◽  
Maurice Madeo
Keyword(s):  
Blood Culture ◽  
Laboratory Test ◽  
Positive Blood Culture ◽  
False Positive ◽  
Adult Population ◽  
Diagnostic Information ◽  
Blood Cultures ◽  
Department Of Health ◽  
Micro Organisms ◽  
Positive Results

The culture of micro-organisms from blood is an essential laboratory test for the diagnosis of bacteraemia. Early positive results provide valuable diagnostic information on which appropriate antimicrobial therapy can be initiated. Like any tests, however, false-positive blood culture results can limit the utility of this important tool. These false-positive results arise due to contamination. Reports from NHS trusts and equipment suppliers suggest these contamination rates could be as high as 10% (Department of Health (DH), 2007). A variety of strategies have been investigated and employed to decrease contamination rates. This article describes the utility of a variety of approaches to reduce the number of false-positive percutaneous blood cultures specifically in the adult population.

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