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Blood Culture Contamination Rate Reduction; A Quality Improvement Plan in the ED

Michelle Deane

Bon Secours Memorial College

NUR4242 DL1-Synthesis of Nursing Practice

Assistant Professor Trina Gardner, MSN,RN

April 1, 2023

I pledge…
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Blood Culture Contamination Rate Reduction; A Quality Improvement Plan in the ED

In the medical community there has been a big push in the prevention and treatment of

sepsis with early blood culture specimen collection playing a vital role. Many times, however,

there has been cases where the specimens collected are contaminated causing the specimen to be

tainted and compromises the final report. Blood culture contaminations can lead to misdiagnosis,

prolonged hospital stays, and even unnecessary antibiotic exposures for our patients

(CDC,2023). This project’s objective and aim was to find ways that would help the nurses in the

ED help reduce in patient length of stay and decrease incidents of misdiagnosis by reducing their

overall blood culture contamination rate.

When I saw one of our rating lists on blood cultures in December, I noticed a trend that

was not good, our blood culture contamination rates had doubled within the last three months.

Our managers knew we had a lot of work to do to help reduce these numbers for our nurses in

our department and jumped on any quality improvement plans. After consulting with Catherine

Citron, our clinical manager, I was better able to get a complete picture of our department issues

and create a focused plan of action. We knew that we had to start with education as it is vital,

along with changing our culture and fine tuning our way of practice. Educating our nurses on

appropriate techniques daily along with written material and daily reminders at huddle allowed

for us all to be on the same level of practice. When obtaining a blood culture specimen,

assistance makes the process better therefore a “buddy system” was enacted allowing for an extra

set of hands and eyes. Many of our blood culture specimens are obtain by using an ultrasound

guided intravenous insertion which has lots of room for errors, therefore we implemented using

certain sterile items and techniques when obtaining the specimen.

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When looking at our department there are some predictions as to the outcome that can be

made as each nurse has different goals and are at different levels of expertise. The department is

currently made up of approximately sixty percent of graduates with less than 2 years of nursing

experience. We expected that because of their novice experience in nursing they would have a

willingness to learn and a desire to focus on patient centered care. We also predicted that

implementing certain rewards for having the knowledge of how to properly collect blood

cultures would also help increase the awareness. We also anticipated that some veteran nurses

may not want to change, and we were not sure if everyone would be on board with the “buddy

system”. We also predicted that the ultrasound machine may have working issues and that many

of the supplies for our ultrasound guided IVs would not be readily available. Overall, we

projected that these measures would help decrease the blood culture contamination rates for our

ED nurses.

We saw that many of the nurses did attend that information sessions and reminders daily

however the daily emails were many times overlooked and seen as a nuisance to some. Our

huddles were especially invigorating when the chances of winning a prize for answering certain

questions pertaining to blood culture collection correct was team building. The “buddy system”

implemented allowed for many within the department to connect and build a rapport among the

department. We did, however notice that some had issues speaking up if there was an error in

practice during the “buddy system”. We did see an overall great professional attitude and

disposition between all coworkers during the buddy system and throughout the entire

improvement project. This help create a culture of teamwork and understanding within all levels

of expertise.
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The willingness to learn and do the correct procedures were also there but there were

many instances where the supplies were not at hand. Supplies played a vital role in collecting the

cultures correctly as if they are not readily on hand the specimens may not be collected properly.

Having the “buddy system “in placed helped with this as if material was missing the person

observing would be able to obtain it for the one performing the procedure. On many days the

acuity was too high and there was not enough staff to conduct a buddy system in the ED causing

a break in the check off system. Supplies also became an issue when performing ultrasound

guided IVs as we had to make sure the unit was always stocked for any emergent procedure. This

became a big problem with our quality improvement project although we attempted to thwart off

this by pre-planning and coordinating with central supply. During our observation of the

ultrasound guided IVs, we also noticed that the teamwork and togetherness approach prevailed

causing many new professional friendships.

The impact to our system of blood culture collection was unintentional as we did not

meet our goal of reducing the blood culture rates overall but we did help foster a more conducive

work environment for all. We were able to bring a greater awareness to our system of collection

as well as sepsis and the warning signs. The overall goal of reducing the contamination rate for

the nursing department, however we were able to target some of our greatest outliers and work

on their troubles regarding obtaining blood cultures. The general positive change in the

department regarding morale and culture was a positive by-product that will have a continue

rippled effect as we can use the approaches we implemented into other improvement projects.

The culture is one of learning and teaching, utilizing the buddy program showed that working

alongside our fellow colleague with the same goal may lead to better outcomes.
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When implementing a quality improvement project like this we had to really focus in on

the approaches that would help not only create change in our practice but also strengthen our

learning. We knew that there were many areas that could be tackled regarding blood culture

contamination but really wanted to focus in on three that would garner us the most optimal

results. We focused in on education, team building, and modification of technique and tried to

streamline everything together trying to maintain the simplest approaches. These focused goals

allowed us to attempt to make the changes needed by connecting with managers, directors and

fellow co-workers regarding each process. We asked questions related to the steps in our plan

regarding effectiveness and significance. We used that data to then change certain ways of

conducting our project such as having a two-person system with the ultrasound guided IVs due

to the overwhelming positive interpersonal connections from the “buddy system”. Reviewing

our data and analyzing it prior to starting our second PDSA cycle paid off greatly for us as it

showed where our strengthens as a team laid.

When reviewing our overall quality improvement project, we realized that we reached

our overall bigger goal but did not meet our focused goal. We can use this to focus on a bigger

overall incidental outcome, change in our culture focusing on more of a positive, team building,

team learning, hands on approach to certain new implementations within the ED. We both

concluded that although we did not reach our stated goal of reducing blood culture contamination

rates, we did help increase the nursing morale. In recent years with COVID and post-COVID we

find that the morale and energy within the ED has been quite low. Many of the older more

experienced nurses have left leaving many newer nurses without a mentor or strong support

system. When we saw the shift of energy and environment within the ED we realized that we can

utilize this type of process to better foster a culture of change regarding teaching and learning.
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We can put back something I have seen disappear in the nursing community within hospitals and

that the family, supportive feeling. Having this change within our department I feel will garner

more positive changes and lead to not only a better working environment but also better quality

of care for our patients. Through this quality improvement project I can see the positives of

having certain measures improved or changed for the betterment of the department as a whole.
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References

CDC. (2023). CDC. Retrieved March 28, 2023, from https://www.cdc.gov/antibiotic-use/core-

elements/pdfs/fs-bloodculture-508.pdf