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Background <p>Appropriate procurement of blood cultures (BC) is essential for diagnosis of bacteremia and susceptibility testing. This includes (1) adequate preparation of the venipuncture site to minimize contamination; (2) obtaining ≥ two sets with a time interval before starting antibiotics. Although these recommendations are standard since the 1960s, adherence is far less than expected – which may adversely impact on the management of bacteremic patients.</p> Aims of study <p>This single-center study conducted in Shaare Zedek Medical Center aimed to decrease the proportion of contaminated BCs and to increase the percentage of obtaining two sets of BC/ blood-culture-taking episode.</p> Methods <p>Determination of both markers at baseline, then monthly for one year, then subsequently on a quarterly basis; showing data from all departments in real-time to all department directors; and providing short educative lectures during departmental staff meetings, at baseline and after 1–2 years. These markers were adopted as one of the hospital-wide quality measures.</p> Results <p>In the 20-year period 2000–2019 more than 1&#xa0;million BCs were obtained, of which 70% were from patients ≤ 72&#xa0;h in hospital. During the 5-year study (2020–2024), the percent of blood-culture-taking episodes from which two culture sets were obtained increased annually by ± 16% from a baseline of 27% (9010/33306) in 2020, to 46% (18462/40191) in 2024 (Incidence Rate Ratios, IRR 1.16 [95%CI 1.13–1.18], <i>p</i> &lt; 0.001). This improvement was observed in almost all departments and was especially profound in the emergency department (ED), starting at a baseline of 19% (1979/10326) and increasing to 53% (5304/9915)(IRR 1.33 [95%CI 1.27–1.39], <i>p</i> &lt; 0.001). During the same period, the annual proportion of false-positive BCs, from which only contaminants were isolated, decreased annually by 18% from 2.4% (1592/65230) in 2020 to 1.3% (895/68991) in 2024 (IRR 0.82 [95%CI 0.77–0.88], <i>p</i> &lt; 0.001). This improvement was observed in all departments: in the emergency department, this rate decreased from 3.3% (676/20529) to 1.56% (272/17459) (IRR 0.79 [95%CI 0.75–0.83], <i>p</i> &lt; 0.001).</p> Conclusion <p>A simple educational intervention, combined with meticulous data mining and presentation of each department’s results, with comparison of all other departments, led to significant and sustained improvement in measurable markers.</p>

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Improving blood culture procurement: a prospective 5-year hospital-wide study

  • 期刊论文

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  • 发表日期：

    2025年12月31日

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  • Shmuel Benenson,
  • Miriam Dreyer,
  • Bath Sheva Ezagui,
  • Ilana Dery,
  • Todd Zalut,
  • Naama Bagrish,
  • Rona Lujan,
  • Marc V. Assous,
  • Amos M. Yinnon,
  • Oshrat Ayalon

摘要

Background

Appropriate procurement of blood cultures (BC) is essential for diagnosis of bacteremia and susceptibility testing. This includes (1) adequate preparation of the venipuncture site to minimize contamination; (2) obtaining ≥ two sets with a time interval before starting antibiotics. Although these recommendations are standard since the 1960s, adherence is far less than expected – which may adversely impact on the management of bacteremic patients.

Aims of study

This single-center study conducted in Shaare Zedek Medical Center aimed to decrease the proportion of contaminated BCs and to increase the percentage of obtaining two sets of BC/ blood-culture-taking episode.

Methods

Determination of both markers at baseline, then monthly for one year, then subsequently on a quarterly basis; showing data from all departments in real-time to all department directors; and providing short educative lectures during departmental staff meetings, at baseline and after 1–2 years. These markers were adopted as one of the hospital-wide quality measures.

Results

In the 20-year period 2000–2019 more than 1 million BCs were obtained, of which 70% were from patients ≤ 72 h in hospital. During the 5-year study (2020–2024), the percent of blood-culture-taking episodes from which two culture sets were obtained increased annually by ± 16% from a baseline of 27% (9010/33306) in 2020, to 46% (18462/40191) in 2024 (Incidence Rate Ratios, IRR 1.16 [95%CI 1.13–1.18], p < 0.001). This improvement was observed in almost all departments and was especially profound in the emergency department (ED), starting at a baseline of 19% (1979/10326) and increasing to 53% (5304/9915)(IRR 1.33 [95%CI 1.27–1.39], p < 0.001). During the same period, the annual proportion of false-positive BCs, from which only contaminants were isolated, decreased annually by 18% from 2.4% (1592/65230) in 2020 to 1.3% (895/68991) in 2024 (IRR 0.82 [95%CI 0.77–0.88], p < 0.001). This improvement was observed in all departments: in the emergency department, this rate decreased from 3.3% (676/20529) to 1.56% (272/17459) (IRR 0.79 [95%CI 0.75–0.83], p < 0.001).

Conclusion

A simple educational intervention, combined with meticulous data mining and presentation of each department’s results, with comparison of all other departments, led to significant and sustained improvement in measurable markers.