Background: Neonatal sepsis is a significant cause of neonatal morbidity and mortality worldwide. Blood culture is the gold standard investigation for making a definitive diagnosis of sepsis; however, contaminants resulting in false positives can limit the reliability of this investigation and lead to inappropriate antibiotic treatment. An audit of blood culture contamination rates performed at a UK level 2 neonatal unit showed a significant increase in the yearly contamination rates over a 2-year period. Available evidence has shown that staff education and the introduction of standardised blood culture collection protocols could significantly reduce the contamination rate. The aim of this study was to assess staff knowledge and confidence in standardised neonatal blood culture collection techniques and then perform a reassessment before and after staff teaching sessions at induction. Method: Thirty-one (31) staff (doctors and nurses) undertaking blood culture collection at the neonatal unit were given printed surveys about their knowledge, confidence, and current practice. The data was then analysed to inform future interventions to reduce contamination rates. Given that the initial survey results highlighted a lack of teaching, poor awareness about the local guideline and suboptimal knowledge regarding best practice to avoid contamination, an induction teaching session on blood culture collection was introduced for a new staff cohort. New staff were then surveyed pre- and post-induction teaching to analyse the teaching’s impact. Results: The initial staff survey showed knowledge gaps in optimal blood culture collection technique, possibly contributing to the neonatal unit’s rising contamination rate. Only 16% of respondents received training on blood culture collection during induction, and only 38.7% were aware of the local guideline on neonatal blood culture collection. Therefore, induction training on neonatal blood culture collection was introduced. Pre- and post-induction teaching surveys showed improvement in staff knowledge about evidence-based techniques to avoid blood culture contamination. Following the teaching, 86% of staff could state that at least 1ml is the recommended blood volume for collection (compared to 73% pre-teaching). Moreover, the percentage of staff who knew to collect the blood culture first, before other samples, rose from 73.3% pre-teaching to 100% post-teaching. While 33% initially thought a 70% alcohol wipe was adequate to clean blood culture bottle tops, post-teaching, they unanimously agreed that 2% chlorhexidine in 70% alcohol was recommended. Additionally, results showed increased awareness about the local guideline and greater levels of confidence in collecting neonatal blood cultures (with 93% rating their confidence highly as 4/5 or 5/5 post–teaching vs. only 20% pre-teaching). Conclusion: This project, created in response to a rising neonatal blood culture contamination rate at a level 2 neonatal unit, showed improved knowledge and confidence about appropriate blood culture collection procedures following induction teaching for new staff cohorts. Additional interventions, including a clinical room poster outlining procedure steps, an updated evidence-based local guideline, and continued staff education sessions, were initiated to reduce the neonatal blood culture contamination rate. A future re-audit of contamination rates is planned to further assess the impact of these educational interventions.
Oakley et al. (Thu,) studied this question.
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