An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients

Regev Cohen, Elias Tannous, Orna Ben Natan, Aliza Vaknin, Mohammed Ganayem, Sharon Reisfeld, Shelly Lipman-Arens, Lamis Mahamid, Linor Ishay, Erez Karisi, Noa Melnik, Mira Leibel, Jalal Ashkar, Sarit Freimann

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield. Methods: We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons. Results: A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected and week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care–associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change. Conclusions: An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.

Original languageEnglish
JournalAmerican Journal of Infection Control
DOIs
StateAccepted/In press - 1 Jan 2024

Keywords

  • Blood cultures
  • Diagnostic stewardship
  • Phlebotomist
  • Single-site strategy

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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