Decreasing blood culture contamination rates in a rural emergency department: a quality improvement initiative

Blood culture contamination rates have been consistently above the national benchmark of 3% in the emergency department (ED) at Mosaic Life Care in St. Joseph, Missouri, USA. Contaminations contribute to negative patient outcomes including unnecessary antibiotic exposure, antibiotic resistance, prolonged hospital stays and delayed treatment plans. Reducing contamination rates is imperative to improving outcomes for both patients and the hospital. This study aimed to decrease blood culture contamination rates at a single, rural hospital institution in 7 months. Quality improvement frameworks guided the construction and implementation of the various countermeasures. Analysis of contamination data was conducted monthly and visualised in a run chart. Contamination rates decreased from 4.42%–3.51% (p<0.002) between September 2023 and October 2023 with Countermeasure 1. Rates fell to 2.9% in January 2024 through implementation of Countermeasure 2. Rates rose briefly to 3.5% in March 2024 but decreased to 2.8% in May 2024 following implementation of Countermeasure 3. Blood culture contamination rates in the ED declined significantly by increasing caregiver awareness via strategic environmental signage and renovating orientation education. The sustainability of this progress requires continued efforts. Maintenance of contamination rates below the national benchmark is targeted with continuous collaboration between clinical partners. This initiative demonstrated the importance of interdepartmental collaboration and communication with all stakeholders involved in quality improvement measures.