6328 A quality improvement project to reduce blood culture contamination rates in a large district general hospital

Objectives Blood cultures are an important diagnostic tool in the management of the febrile child. Blood culture contamination is a significant issue that can lead to negative patient outcomes, including over-investigation for occult bacteraemia, prolonged hospital stays, unnecessary antibiotic use and parental worry.1 2 3 The national standards for expected blood culture contamination rates are 3%.4 We performed an audit to compare our contamination rates against the national standard and implemented measures to improve our performance, with a view of re-auditing to complete our quality improvement cycle in March 2024. Methods We performed a retrospective audit of blood cultures taken within the neonatal unit, paediatric inpatient wards, and paediatric emergency department over an 18-month period. Demographic data was obtained, along with blood culture result. Microbiological and clinical correlation was performed to determine if the blood culture was a contaminant or not. We also identified final diagnosis of patients who had a contaminant in their blood culture. Results 2142 blood cultures were performed within paediatrics and neonates, out of which 145 were positive. We identified 37 positive blood cultures and 108 contaminants. The breakdown of blood culture contamination rates is shown in table 1. The lowest contamination rate was within neonates at 1.1%, and the highest contamination rate was within the paediatric emergency department (6%). Figure 1 shows the likely organisms which were contaminants, with the majority being staphylococcus epidermidis. This was presented at our departmental meeting and contributing factors were identified, including lack of training for juniors regarding aseptic non touch technique in paediatrics, lack of ancillary supporting staff during blood taking procedures, absence of a protocol for blood culture taking and high turnover of medical staff from different training schemes. Conclusion Our audit showed that blood culture contamination rates are higher than national average in our hospital, especially in paediatric emergency department. We have since designed changes to be implemented including blood culture taking training at induction, a checklist for cannulation procedures and blood culture taking in the paediatric emergency department and regular review of staff competency in blood culture taking in paediatrics. We aim to complete our Plan-Do-Study-Act cycle by re-auditing blood culture contamination rates between March and August 2024. References Segal GS, Chamberlain JM. Resource utilization and contaminated blood cultures in children at risk for occult bacteremia. 2000. Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. 2009. Waltzman ML, Harper M. Financial and clinical impact of false-positive blood culture results. 2001. Bentley J, Thakore S, Muir L, Baird A, Lee J. A change of culture: reducing blood culture contamination rates in an emergency department. 2016.