Date of Award

Fall 2022

Project Type

Thesis

College or School

CHHS

Department

Nursing

Program or Major

Direct Entry Master in Nursing

Degree Name

Master of Science

First Advisor

Pamela Kallmerten

Abstract

Background: The diagnosis of sepsis in a patient presenting with symptoms includes the collection of blood cultures which identifies the presence of specific infectious agents. The culture result will identify the organism as well as report sensitivity to various antimicrobial agents to allow the healthcare provider to determine the specific set of treatments, specifically antibiotics, that will be included in the medication regimen in combating the infection. When blood specimens become contaminated in the collection process, it hinders the success of rapidly treating these patients as repeat cultures will likely need to be completed for accurate treatment. This becomes a difficult task if broad spectrum antibiotics have already been started after the initial blood culture. Once antibiotics are started the blood culture may be further skewed making it difficult to successfully treat the patient. This makes proper initial blood culture collection imperative for the care plan. With patients at the center of our healthcare system, it is important to be as accurate as possible from the beginning to avoid any contaminated results which could lead to a delay in patient care. Research has shown that continuing education is beneficial to nurses in refreshing their skill set, and in turn, allowing them to be successful and accurate (Dargere, Cormier, and Verdon, 2018).

Local Problem: It is imperative to monitor blood culture specimen contamination rates to identify opportunities for improvement. With the results obtained after education, and based on staff response, the sepsis committee and team leads can make further decisions on how to proceed. This information allows them to review what works best in order to continue to improve the rate of contamination and make changes accordingly in the future.

Methods: With the assistance of facility staff members, educational information was posted in areas of the microsystem that are frequented by nurses responsible for collecting blood cultures. The goal of the posted information was to remind staff of the existing protocols and small steps that should be taken to reduce contamination.

Results: Over a short period of time, and comparing previous rates to those after educational information was introduced, it was obvious that contamination rates had decreased even with a high volume of blood culture collections. The average contamination rate for the first two quarters of 2022 were noted to be 1.9% and 2.5%. 47 staff were noted to have at least one occurrence for a contaminated specimen with 20 staff having multiple occurrences. The site most frequently contaminated was the Right Antecubital. After the introduction of education there was a decrease in contamination with a rate of 0.7% for that month.

Conclusions: After reviewing both the literature and results of this quality improvement project, it appears that continuing education is of benefit to reducing contamination rates. By reducing contamination rates of blood cultures, patients will receive timely and efficient care. The facility will also benefit in terms of reducing cost of supplies for repeat cultures and testing.

Keywords: blood culture, contamination, education, healthcare costs, microorganisms in blood, protocol, specimen collection, professional development, SIRS criteria, rates of contamination

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