An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients - 09/05/24
, Elias Tannous, MSc b, g, Orna Ben Natan, PhD a, Aliza Vaknin, MN a, Mohammed Ganayem, MHA a, Sharon Reisfeld, MD a, f, Shelly Lipman-Arens, MD a, f, Lamis Mahamid, MD a, f, Linor Ishay, MD a, f, Erez Karisi, MBA c, Noa Melnik, BSc c, Mira Leibel, RN d, Jalal Ashkar, MD d, Sarit Freimann, PhD eRésumé |
Background |
Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield.
Methods |
We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons.
Results |
A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected per week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care–associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change.
Conclusions |
An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Diagnostic stewardship of blood cultures is frequently poor. |
• | ED intervention was based on switching to single-site strategy for blood culturing. |
• | Admission blood cultures number increased, and solitary blood cultures reduced. |
• | Community-onset bloodstream infections detection increased after the intervention. |
• | There was no increase in blood-culture contamination rates. |
Key Words : Blood cultures, Single-site strategy, Diagnostic stewardship, Phlebotomist
Plan
| Conflicts of interest: None to report. |
Vol 52 - N° 6
P. 664-669 - juin 2024 Retour au numéro
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