Attachment SE1EOe, Blood Culture Collection Educational Program

Shore Health

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Attachment SE1EOe, Blood Culture Collection Educational Program

Why Culture Blood?  Micro-organisms present in a patient’s blood are a threat to every organ in the body and can cause serious illness and/or death if not treated promptly with the right antibiotics.  Blood cultures are performed to : • find micro-organisms • rule out the presence of microorganisms in the patient’s blood.

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Attachment SE1EOe, Blood Culture Collection Educational Program

Skin – Because skin has its own normal flora, bacteria present on the patient’s skin can contaminate the tip of the needle and enter the blood flowing into the blood culture bottles causing the blood culture to become falsely positive if the venipuncture site is not adequately cleansed. Bacteria from the collector’s fingers or hands and exposure of the sterile collection supplies to environmental surfaces like the bed or bed-side table can also be a source of blood culture contamination. Improper technique leads to blood culture contamination Proper site preparation and aseptic technique are paramount to a successful blood culture collection. Blood Culture Contamination Consequences • The patient may be treated for an organism that is not present in the bloodstream. • The contaminant may “overgrow” the pathogen so it will never be recovered. The patient may go untreated for a life-threatening infection. 3

Attachment SE1EOe, Blood Culture Collection Educational Program

Contamination Consequences Cost and Increased Length Of Stay • Length of stay increased by 4.5 days • Cost increase of $5,000 - $8,800. (1,2) Contributes To Bacterial Resistance • Needless antibiotic treatment leads to creation of drug resistant bacteria Confusion- when and when NOT to treat • Physician must make a decision over treatment on unreliable results • May cause an unnecessary delay in patient care

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Attachment SE1EOe, Blood Culture Collection Educational Program

Blood Culture Collection Pre-Analytical Variables Timing and Draw Sites “Routine” blood cultures: • should be drawn 15 minutes apart and • from different sites unless otherwise specified by the physician When it is necessary to draw 2 sets of blood cultures at the same time, they should be drawn from 2 different sites. • You may perform 2 separate cleansings/ venipuncture events on the same extremity if drawing from 2 different extremities is impossible.

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Attachment SE1EOe, Blood Culture Collection Educational Program

Skin Preparation (patients > 2 mos. old) 1. 2. 3. 4.

Locate the vein to be used. If skin is visibly dirty, wash with soap and water. Dry. Wipe area with alcohol prep pad. Prep the ChloraPrep® FREPP sponge. • Squeeze wings to release solution. • Press the sponge against the skin surface to be cleansed, saturating it. 5. Vigorously scrub the area for 30 seconds using a back and forth motion. • This removes loose skin cells and sterilizes the area • The scrubbing should continue for a full 30 seconds, allowing the chlorhexidene solution to reach into the cracks and fissures of the skin surface surface 6. Allow area to air dry for about 30 seconds. Avoid touching the prepared venipuncture site!! Poor skin preparation in the #1 cause of BC contamination!!! 6

Attachment SE1EOe, Blood Culture Collection Educational Program

Skin Preparation (Patients < 2 months old) (11) • • • • •

Locate the vein to be used. Using a Betadine preparation, scrub the area thoroughly. Allow the Betadine to dry. Perform the venipuncture. After blood has been collected, remove the Betadine from the infant’s skin with a sterile saline prep.

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Attachment SE1EOe, Blood Culture Collection Educational Program

Bottle Choice One pair of Aerobic and Anaerobic bottles. – Use of paired Aerobic and Anaerobic bottles for each set drawn recovers more pathogens compared to use of aerobic bottles only. (4,5,6) Pediatric - Peds Plus bottles are used for pediatric blood cultures. One bottle per blood culture order/ set. Resin - The Plus Aerobic bottle is used only when the physician has ordered use of Antimicrobial Removal Resins Bottles for Blood Cultures. Substitute for Standard Aerobic Bottle. Fungal - Myco/F –Lytic use upon physician order for fungal blood cultures. Obtain 2 bottles from Lab for each order. 8

Attachment SE1EOe, Blood Culture Collection Educational Program

Specimen Volume • Successful recovery of bacteria from a blood culture is highly dependent on collection of an adequate volume of blood without overfilling the BD BACTEC® bottles. Under-filling the bottles: may cause bacteremia to go undetected Overfilling the bottles : causes false positive readings on the Bactec blood culture instrument.

Goal: Draw the maximum optimum blood volume

Bottle Type

Fill Volume

Standard Aerobic Blue lid

8-10 mL

Anaerobic Purple lid

8-10 mL

Plus Aerobic Gray lid

8-10 mL

Mycolytic (fungal)Whit e lid

8-10 mL

Pediatric Pink lid

1-3 mL

The yield of pathogens detected in a blood culture increases in direct proportion to the volume of blood that is cultured. (3) 9

Attachment SE1EOe, Blood Culture Collection Educational Program

Order of Draw • Always draw Blood cultures first! • When combining blood cultures with other lab test specimens draw blood cultures first. • Be sure the adapter or transfer device needle does not touch the top of a tube that has not been cleaned. • Use Aseptic technique.

• Fill the Aerobic bottle first • Any air in the tubing should go into the aerobic bottle, not the anaerobic bottle • When less that recommended volume of blood is obtained, inoculate the aerobic bottle first. Most bacteria recover better in this environment.

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Attachment SE1EOe, Blood Culture Collection Educational Program

Aseptic Technique • Strict aseptic technique must be followed throughout the collection. – Gather proper equipment and stage area. • Do not open and place sterile equipment on a non-sterile surface. • Keep the equipment in the opened wrappers until ready to use. – Use proper PPE – If drawing blood culture and other lab test specimens togetherBlood culture bottles must ALWAYS be drawn and filled prior to drawing the other lab test tubes so that the adapter or transfer device needle does not touch the top of a tube that has not been cleaned – It is best practice to draw blood cultures by venipuncture. • Drawing blood from an IV catheter can significantly increase blood culture contamination with skin organisms, even if the IV catheter is newly inserted. (7,8,9,10) • Blood cultures should NOT be collected through an IV catheter, whether it is a newly inserted IV catheter or an established IV, unless investigating a possible established IV line catheter-caused bloodstream infection by drawing simultaneous catheter and venous specimens. 11

Attachment SE1EOe, Blood Culture Collection Educational Program

Equipment Scenario 1 (Direct Draw) • Sterile Alcohol Pads • Tourniquet • ChloraPrep® FREPP® sponge • Sterile Safety-Lok Blood Collection Set (butterfly) with pre-attached holder • Blood Culture Bottles

Scenario 2 (Syringe and Transfer Device) • • • •

Sterile Alcohol Pads Tourniquet ChloraPrep® FREPP® sponge Winged Blood Collection Set (butterfly) • Sterile 3-20cc syringe • Blood Transfer Device • Blood Culture Bottles

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Attachment SE1EOe, Blood Culture Collection Educational Program

BLOOD VOLUME On rare occasions, it may be impossible to collect the desired amount of blood. In that case, there is flexibility: Blood Volume

Instruction

10-20 mL

Using equal volume, inoculate the Aerobic and Anaerobic bottles

3-9 mL

Inoculate Aerobic bottle only