scholarly journals The San Luigi Gonzaga Hospital experience: improving blood and urine culture preanalytical quality by shared protocols

2017 ◽  
Vol 32 (2) ◽  
Author(s):  
Angela Samiolo ◽  
Elena Ardizzi ◽  
Angela Ardizzola ◽  
Ornella Bianco ◽  
Anna Rita De Luigi ◽  
...  
Keyword(s):  
Blood Culture ◽  
Risk Analysis ◽  
Prospective Observational Study ◽  
Urine Culture ◽  
Blood Cultures ◽  
Time Intervals ◽  
The Individual ◽  
Sampling Procedures ◽  
Prospective Monitoring

<em>Background and aims:</em> Reduction in the number of blood culture and urine culture contamination samples. <br /><em>Materials and methods:</em> We have designed a partly retrospective and partly prospective observational study. On one hand, we have been striving for the creation, dissemination and promotion of shared operational rules in all departments/hospital services to improve the quality of the levy; on the other hand, we analysed data. We considered blood cultures and urine cultures analysed in the laboratory from March to August 2015, and from March to August 2016. The data were processed with R and the incidence of contaminated samples was calculated by dividing the number of blood cultures/urine cultures contaminated by the total. The results of 2015 and 2016 were compared by χ2. To highlight the possible differences between departments and identify those at higher risk of contamination, the data of each year were stratified dividing departments into five groups: Medicine, Surgery, Critical Area, Specialties and ER. To assess the strength of the association, a risk analysis was carried out using the risk ratio (RR). The RR was calculated by dividing the contamination rates of 2015 by the those of 2016. The value of α was set at 0.05. <br /><em>Results</em>: After implementation of the shared protocols, blood culture contamination was substantially reduced (−56.8%, P=1.783e-05), confirmed by an RR of 2.2 (95%CI: 1.54±3.27). The evidence is strengthened by the finding of a lower number of isolates belonging to the group of possible contaminants (−32.7%, P=2.042e-07) and confirmed by an RR of 1.5 (95%CI: 1.27±1.73). Urine culture data analysis showed no change in the incidence of contamination between 2015 and 2016 (P=0.8808), as confirmed by a non-informational RR (95%CI: 0.62±1:46). Even the analysis of the individual areas showed no change in the two semesters, as confirmed by the risk analysis that does not show any association between outcome and group. <br /><em>Conclusions</em>: The results confirm the value of multidisciplinary work and encourage us to continue the path of standardisation and updating of the sampling procedures, as well as the prospective monitoring and comprehensive analysis of the data collected for longer time intervals.

scholarly journals Quality of Life in Patients with Nasal Obstruction after Septoplasty: A Single Institution Prospective Observational Study

2021 ◽  
Author(s):  
Justyna Dąbrowska-Bień ◽  
Henryk Skarżyński ◽  
Sebastian Filip Górski ◽  
Piotr Henryk Skarżyński
Keyword(s):  
Quality Of Life ◽  
Observational Study ◽  
Nasal Obstruction ◽  
Prospective Observational Study ◽  
Common Symptom ◽  
Single Institution ◽  
High Satisfaction ◽  
Symptom Evaluation ◽  
The Individual

Abstract Introduction Nasal obstruction is a common symptom in otorhinolaryngological practice. It can impact significantly on the quality of life of the individual. Objective The primary goal of the present study was to evaluate quality of life after septoplasty in adults with nasal obstruction. A secondary goal was to assess the effectiveness of septoplasty. Methods This was a single institution prospective observational study. Patients had experienced septal deviation and symptomatic nasal obstruction with no benefit from medical treatment. There were 51 patients who completed the Nasal Obstruction Symptom Evaluation (NOSE-POL) scale as well as theVisual Analogue Scale (VAS) before undergoing septoplasty, 3 months later, and finally 7 months after surgery. Patients evaluated changes in their nasal obstruction and changes in their quality of life using the Clinical Global Impression Scale (CGI-S). Results There was a significant improvement in nasal obstruction after septoplasty. Before septoplasty, the mean score on NOSE was 60.3 ± 20.4; 3 months after surgery, it was 32.9 ± 16.8; and 7 months after surgery it was 39.6 ± 33.2. The VAS results also proved a significant enhancement in nasal obstruction after septoplasty. Patients reported an improvement in nasal obstruction as well as a positive change in quality of life, confirming the effectiveness of septoplasty. Conclusions In patients with deformed septum, septoplasty contributes to high satisfaction of the patient and a compelling improvement in disease-specific quality of life. The NOSE-POL questionnaire is a useful tool for measuring the outcomes of this procedure.

scholarly journals Identification of Potentially Unnecessary Micafungin Use Patterns: Opportunities for Antifungal Stewardship Interventions

2021 ◽  
Vol 1 (S1) ◽  
pp. s32-s33
Author(s):  
Miguel Chavez Concha ◽  
Kevin Hsueh ◽  
Michael Durkin ◽  
Andrej Spec
Keyword(s):  
Blood Culture ◽  
Urine Culture ◽  
Tracheal Aspirate ◽  
Culture Collection ◽  
Blood Cultures ◽  
Urine Specimen ◽  
Antifungal Stewardship ◽  
Microbiological Test ◽  
First Line Therapy ◽  
Patterns Of Use

Background: Echinocandins are used as first-line therapy for suspected and confirmed Candida spp, and its indiscriminate use may drive selection for echinocandin resistance. We evaluated patterns of use of micafungin to identify opportunities for antifungal stewardship. Methods: We identified all micafungin completed orders and microbiological test result data from July 2018 to November 2020 among hospitalized patients in Barnes-Jewish Hospital. Continuous micafungin courses with <48 hours of interruption were considered independent courses. We evaluated micafungin use in 3 scenarios in which its use may be unnecessary: (1) patients with blood cultures negative for Candida spp, (2) patients with recovery of yeast or Candida spp from tracheal aspirates, and (3) patients with recovery of yeast or Candida spp from urine cultures. We only included micafungin courses if they were initiated within 5 days of blood culture collection or up to 4 days after tracheal or urine culture collection to account for incubation and decision to initiate treatment. Results: We found 3,381 micafungin courses in 3,287 admissions. Of these, 2,532 courses had blood culture collection around micafungin initiation and were included in the first analysis: 1,879 (74%) were negative, 149 (6%) had Candida spp isolated in the blood, and 504 (20%) had positive blood cultures for other organisms. Micafungin was given for a median duration of 3 days (IQR, 2–7) to those with negative blood cultures and for 3 days (IQR, 1–5) to those with positive blood cultures without candidemia (p < 0.001), and prolonged durations of more than 5 days was seen in 768/1879 (41%) and 143/504 (28%) of courses, respectively (p <0.001). A total of 487 micafungin courses were initiated after tracheal aspirate culture collection. Those with yeast isolated (n = 100, 21%) received similar micafungin duration compared to those that had no yeast isolated [3 (2-7 IQR) vs. 3 (2-7) days, respectively; p = 0.56). Finally, a total of 844 micafungin courses started after urine culture collection. A total of 49 (6%) had yeast isolated from the urine and treatment duration was similar to those that did not [3 (1-6 IQR) vs. 3 (2-6) days, respectively; p = 0.87). Conclusions: Echinocandin treatment courses did not differ when a yeast was identified from a tracheal isolate or urine specimen. However, a substantial proportion of treatment courses were prolonged in those with negative Candida spp in the blood, suggesting opportunities for antifungal stewardship interventions.Funding: NoDisclosures: None

Validation of manual blood culture bottles  v2

2021 ◽  
Author(s):  
Sien Ombelet ◽  
Liselotte Hardy ◽  
Jan Jacobs
Keyword(s):  
Blood Culture ◽  
Blood Cultures ◽  
Automated System ◽  
Low Resource Settings ◽  
Low Resource ◽  
System P ◽  
Acceptable Quality ◽  
Personal Experiences ◽  
Laboratory Protocol

Use of equipment-free, “manual” blood cultures is still widespread in low-resource settings, as requirements for implementation of automated systems are often not met. Quality of manual blood culture bottles currently on the market, however, is usually unknown. An acceptable quality in terms of yield and speed of growth can be ensured by evaluating the bottles using simulated blood cultures. In these experiments, bottles from different systems are inoculated in parallel with blood and a known quantity of bacteria. Based on literature review and personal experiences, we propose a short and practical protocol for an efficient evaluation of manual blood culture bottles, aimed at research or reference laboratories in low-resource settings. This laboratory protocol was used in a study for Médecins Sans Frontières' Mini-Lab project, which aims to bring clinical bacteriology to low-resource settings. Three bottle types were evaluated in this study; two "manual" blood culture bottles and one automated system.

Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru

2021 ◽  
Author(s):  
Fiorella Krapp ◽  
Claudia Rondon ◽  
Catherine Amaro ◽  
Evelyn Barco-Yaipén ◽  
María Valera-Krumdieck ◽  
...  
Keyword(s):  
Blood Culture ◽  
Quality Indicators ◽  
High Frequency ◽  
Scaling Up ◽  
Blood Cultures ◽  
Public Hospitals ◽  
Contamination Rate ◽  
Median Frequency ◽  
Missed Opportunities

Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0–15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1–8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6–12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 – 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (30.1%, 95/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.

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 Cultures in Ambulatory Patients Who Are Discharged from Emergency with Community-Acquired Pneumonia

2004 ◽  
Vol 15 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Thomas J Marrie
Keyword(s):  
Escherichia Coli ◽  
Multivariate Analysis ◽  
Blood Culture ◽  
Clinical Judgment ◽  
Prospective Observational Study ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Site Specific ◽  
E Coli ◽  
Ambulatory Patients

OBJECTIVES: To determine the factors that predict whether or not ambulatory patients with community-acquired pneumonia (CAP) treated in an emergency room (ER) setting will have blood cultures drawn and the factors that predict a positive blood culture.METHODS: Prospective observational study of all patients with a diagnosis of CAP, as made by an ER physician, who presented to any of seven Edmonton-area ERs over a two-year period.RESULTS: Seven hundred ninety-three (19.2%) of 4124 patients with CAP had blood cultures drawn. The site-specific blood culture rates ranged from 7.8% to 25% (P<0.001); 41 of 793 (5.1%) were positive.Streptococcus pneumoniaeaccounted for 58.5% of the isolates whileStaphylococcus aureusandEscherichia colieach accounted for 14.6%, or six patients each. Only two of the 24 patients withS pneumoniaebacteremia were subsequently admitted to hospital while all six of the patients withS aureuswere admitted. Only one of the six patients withE colibacteremia was treated at home. No factors were predictive of positive blood cultures on multivariate analysis.CONCLUSIONS: Physicians are selective in ordering blood cultures on patients with ambulatory pneumonia who present to an ER, and the positivity rate of 5.1% is quite high. No factors are predictive of positive blood cultures on multivariate analysis, thus clinical judgment has to prevail in the decision to perform blood cultures. Breakthrough bacteremia can occur with microorganisms susceptible to the antibiotics that the patient is receiving.

scholarly journals Headmasters’ Leadership Styles and their Significant Impact on the General Performance in Schools: Using the Basic Schools in Adansi-South District in Ghana as a Study

2020 ◽  
Vol 12 (3) ◽  
pp. 96
Author(s):  
Eric Amankwah ◽  
Zhou Guo-Hua
Keyword(s):  
Leadership Styles ◽  
Leadership Style ◽  
Democratic Leadership ◽  
Analysis Technique ◽  
Teachers And Students ◽  
Autocratic Leadership ◽  
The Individual ◽  
Sampling Procedures ◽  
School Heads

The main concepts and definitions of leadership and its styles differ in many ways. Thus; from one individual or position to the other. The word "leadership" is used in different circles of human endeavours, for example, in the political, business, academics, social and institutional spheres. In the early on, leadership was seen as a personal trait. The degree to which the individual exhibits leadership traits depends not only on his characteristics and personal abilities but also on the characteristics of the situation and environment in which he finds himself (Messick & Kramer, 2004). This study was conducted on the motivation that no country develops and succeeds better than the quality of the leaders who manage the educational system. This means that for a country to be successful, it depends largely on the quality of leadership that the school managers offer in the schools they manage in the development of skills and potential of the students for the country. The study employed a qualitative research method in the work. The data was collected from Adansi-South District in Ashanti Region in Ghana. Random purposive sampling procedures were adopted with a sample size of forty (40) respondents including heads of schools, teachers, and students. Data were collected through interviews, documentary reviews, and observations. They were analyzed through the use of content analysis technique and other renowned data software such as Excel, and SPSS 22 in the data computations. The findings and policy suggestions at the end of the research concluded that the autocratic leadership is useful if something has to be achieved in the short term and democratic leadership style is usually the most preferable in most situations. Participation leadership style is the most useful because it has a long term effect on employees in a more positive way. School heads who normally applied unreasonable laissez-faire and autocratic leadership styles failed in their schools’ goals, visions and missions implementations due to lack support and cooperation.

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.

scholarly journals Recovery of yeast from vented blood culture bottles

1975 ◽  
Vol 2 (1) ◽  
pp. 18-20
Author(s):  
G D Roberts ◽  
C Horstmeier ◽  
M Hall ◽  
J A Washington
Keyword(s):  
Blood Culture ◽  
Clinical Studies ◽  
Brain Heart Infusion ◽  
Blood Cultures ◽  
Time Interval ◽  
Time Intervals ◽  
The Mean ◽  
Mean Time ◽  
Brain Heart Infusion Medium

Rates of isolation of yeasts from blood cultures were significantly enhanced by venting vacuum blood culture bottles in studies of both stimulated and patients' blood cultures; however, the time interval to detection of positivity of yeasts in the clinical studies was significantly (P less than 0.01) shorter in a vented bottle with biphasic brain heart infusion medium than in a vented bottle with soybean-casein digest broth. The mean time intervals to detection of positivity were 2.6 days in the former and 5.2 days in the latter.

scholarly journals Agreement between Parallel Canine Blood and Urine Cultures: Is Urine Culture the Poor Man's Blood Culture?

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Nanelle R. Barash ◽  
Adam J. Birkenheuer ◽  
Shelly L. Vaden ◽  
Megan E. Jacob
Keyword(s):  
Blood Culture ◽  
Urine Culture ◽  
Bloodstream Infections ◽  
Kappa Statistic ◽  
Blood Cultures ◽  
Predictive Values ◽  
Content Type ◽  
Urogenital Infection ◽  
Urinary Infections ◽  
Urine Specimens

ABSTRACT Bloodstream infections are a significant cause of morbidity and mortality in critically ill dogs, but due to cost and difficulties in sample acquisition, blood cultures are infrequently obtained. In ill dogs, urine cultures may be recommended as surrogates for blood cultures. In order to determine the outcome agreement between parallel urine and blood cultures, we retrospectively analyzed parallel blood and urine specimens submitted for culture from dogs at the NC State Veterinary Hospital between 2011 and 2016. Positive cultures were reported from 15% of the submitted blood specimens and 23% of the submitted urine specimens. A total of 295 urine and blood samples were submitted in parallel, with positive growth demonstrated in 14 concordant and five discordant pairs. A kappa statistic comparing blood and urine culture outcomes was 0.266 (fair) when all parallel growth was included, including concordant and discordant results, and 0.170 (poor) when restricted to parallel concordant growth. The sensitivity of urine to reflect concordant bloodstream bacterial organisms was 30%, with a specificity of 87%. The positive and negative predictive values were 30% and 88%, respectively. Of dogs with both specimens positive on bacterial culture, 7 of 7 (100%) with suspected urogenital infection sources were concordant. All dogs with discordant bloodstream and urinary infections were immunosuppressed. Urinary coagulase-positive Staphylococcus isolates were most likely to be concordant with bloodstream infections. In conclusion, we found that urine culture is neither a substitute nor a screen for blood culture. Blood cultures should be performed in any potentially septic animal, especially those that are considered immunosuppressed.

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