The Sum of the Parts Is Greater Than the Whole: Reducing Blood Culture Contamination (2011)

Editorials1 February 2011The Sum of the Parts Is Greater Than the Whole: Reducing Blood Culture ContaminationJi Yeon Kim, MD, MPH and Eric S. Rosenberg, MDJi Yeon Kim, MD, MPHFrom Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.Search for more papers by this author and Eric S. Rosenberg, MDFrom Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-3-201102010-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Determining whether a positive blood culture represents contamination at the time of collection or a true bloodstream infection is a common, time-consuming problem for physicians and clinical microbiologists. Contamination rates for routine blood cultures are estimated to range from 0.6% to more than 6% of all cultures, potentially resulting in unnecessary hospital admissions, prolonged length of stay, increased laboratory costs, and inappropriate use of antimicrobial therapy (1). False-positive blood cultures may increase laboratory costs by about 20% and are associated with a 39% increase in intravenous antibiotic charges (2); 1 university-affiliated hospital estimated the annualized cost of 6% contaminated blood ...References1. Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev. 2006;19:788-802. [PMID: 17041144] CrossrefMedlineGoogle Scholar2. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. 1991;265:365-9. [PMID: 1984535] CrossrefMedlineGoogle Scholar3. Zwang O, Albert RK. Analysis of strategies to improve cost effectiveness of blood cultures. J Hosp Med. 2006;1:272-6. [PMID: 17219512] CrossrefMedlineGoogle Scholar4. Clinical and Laboratory Standards Institute. Principles and procedures for blood cultures. Approved guideline. Document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Google Scholar5. Richter SS, Beekmann SE, Croco JL, Diekema DJ, Koontz FP, Pfaller MA, et al. Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm. J Clin Microbiol. 2002;40:2437-44. [PMID: 12089259] CrossrefMedlineGoogle Scholar6. Wang SJ, Kuperman GJ, Ohno-Machado L, Onderdonk A, Sandige H, Bates DW. Using electronic data to predict the probability of true bacteremia from positive blood cultures. Proc AMIA Symp. 2000;:893-7. [PMID: 11080013] MedlineGoogle Scholar7. Patton RG, Schmitt T. Innovation for reducing blood culture contamination: initial specimen diversion technique. J Clin Microbiol. 2010;48:4501-3. [PMID: 20943870] CrossrefMedlineGoogle Scholar8. Kim NH, Kim M, Lee S, Yun NR, Kim KH, Park SW, et al. Effect of routine sterile gloving on contamination rates in blood culture. A cluster randomized trial. Ann Intern Med. 2011;154:145-51. LinkGoogle Scholar9. Schifman RB, Strand CL, Meier FA, Howanitz PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med. 1998;122:216-21. [PMID: 9823858] MedlineGoogle Scholar10. 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. J Clin Microbiol. 1997;35:563-5. [PMID: 9041389] CrossrefMedlineGoogle Scholar11. Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol. 2003;41:2275-8. [PMID: 12791835] CrossrefMedlineGoogle Scholar12. Baron EJ, Weinstein MP, Dunne WM, Yagupsky P, Welch DF, Wilson DM. Blood Cultures IV. Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech). Washington, DC: American Society for Microbiology, ASM Pr; 2005. Google Scholar13. Bryant JK, Strand CL. Reliability of blood cultures collected from intravascular catheter versus venipuncture. Am J Clin Pathol. 1987;88:113-6. [PMID: 3604983] CrossrefMedlineGoogle Scholar14. Suwanpimolkul G, Pongkumpai M, Suankratay C. A randomized trial of 2% chlorhexidine tincture compared with 10% aqueous povidone-iodine for venipuncture site disinfection: Effects on blood culture contamination rates. J Infect. 2008;56:354-9. [PMID: 18407355] CrossrefMedlineGoogle Scholar15. Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med. 1999;159:821-6. [PMID: 10219927] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Ji Yeon Kim, MD, MPH; Eric S. Rosenberg, MDAffiliations: From Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2875.Corresponding Author: Eric S. Rosenberg, MD, Massachusetts General Hospital, Gray J-504, 55 Fruit Street, Boston, MA 02114-2696; e-mail, [email protected]org.Current Author Addresses: Dr. Rosenberg: Massachusetts General Hospital, Gray J-504, 55 Fruit Street, Boston, MA 02114-2696.Dr. Kim: Department of Pathology, Massachusetts General Hospital, Warren 225, 55 Fruit Street, Boston, MA 02114-2696. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffect of Routine Sterile Gloving on Contamination Rates in Blood Culture Nak-Hyun Kim , Moonsuk Kim , Shinwon Lee , Na Ra Yun , Kye-Hyung Kim , Sang Won Park , Hong Bin Kim , Nam-Joong Kim , Eui-Chong Kim , Wan Beom Park , and Myoung-don Oh Metrics Cited byImpact of Blood Culture Contamination on Patients and Health Care Systems: A Review of QI Strategies Within the EDEconomic health care costs of blood culture contamination: A systematic reviewRate of blood culture contamination in a teaching hospital: A single center studyBlood culture contaminants 1 February 2011Volume 154, Issue 3Page: 202-203KeywordsAntibioticsAntimicrobialsBacteremiaBloodCathetersEmergency departmentHealth care providersPhlebotomyResearch laboratoriesStaphylococcus aureus ePublished: 1 February 2011 Issue Published: 1 February 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. 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