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Blood Cultures

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Title: Blood Cultures


1
Blood Cultures
2
Learning Outcomes
  • On completion of this resource you should be able
    to
  • Understand the appropriate use of blood
    cultures as a clinical test
  • Describe the rationale for utilising an Aseptic
    Technique in taking blood cultures
  • Describe how to ensure an effective Aseptic Non
    Touch Technique when taking blood cultures

3
What is a blood culture ?
  • A microbiological culture of the blood to detect
    infection with a micro organism, specifically
    bacteria or candida.
  • The blood is usually a sterile substance.
  • If an organism grows - more tests will identify
    type and antibiotic sensitivity

4
Contamination
  • Growth of organisms in the blood culture bottle
    that were
  • not present in the patients blood stream
  • Introduced during sample collection from
  • Patients skin,
  • Equipment used to take sample and transfer it to
    bottle
  • Hands of the person taking sample
  • Contamination rates
  • Estimated that at present 10 of all blood
    cultures in Scotland are contaminated.
  • Aiming for an in patient rate of lt3.

5
Contamination of samples has important
consequences
  • Patient
  • Unnecessary investigations
  • Errors in clinical interpretation
  • Administration of inappropriate treatment
  • 2. Inappropriate use of antibiotics
  • Potentiates emergence of multi-resistant
    organisms
  • Increases risk of Clostridium difficile infection
  • 3. Cost to the health service
  • Average length of stay increased by 4.5 days
  • Average overall cost of treatment increased by
    5,500

6
Contamination of samples has important
consequences
  • 4. Surveillance
  • Decreases accuracy of surveillance data on
    septicaemia
  • 5. Performance management
  • Negatively affects performance management targets
    around patient safety

7
Indications for Blood Cultures
  • Presence of 2 or more of SIRS (Systemic
    Inflammatory Response Syndrome) criteria
  • Core Temperature lt36 orgt38
  • Respiratory Rate gt20 per min
  • WCC gt12 or lt4 x109
  • Pulse gt90bpm
  • Altered mental state
  • BMgt 8mmol (if not a diabetic)
  • Even if only one of these criteria is present
    there may be clinical indications to take a Blood
    Culture sample

8
When to take Blood Cultures?
  • When
  • After indications met
  • Before administration of antibiotics or a change
    of antibiotics
  • If patient is on antibiotics, blood cultures
    should be taken immediately before next dose
    (with exception of paediatric patients).
  • How many sets of cultures?
  • Obtaining more than one set of cultures
  • Significantly increase the sensitivity of the
    test
  • Assists with determining whether a sample is
    contaminated

9
Taking Blood Cultures - venepuncture
  • The site that blood is taken from has significant
    impact on the
  • potential for a culture to be contaminated
  • For venepuncture avoid
  • Femoral vein - adequate skin disinfection
    difficult
  • Existing peripheral cannulae
  • Sites above peripheral cannulae
  • Drawing multiple sets from a single puncture

10
How to take Blood Cultures
  • Equipment required
  • Sharps bin
  • Gloves (non-sterile)
  • Needle and Syringe or Safety Blood Collection
    system
  • Alcohol based disinfectant
  • Dressing as required
  • Blood Culture bottles (plus other vacutainers if
    required)
  • Blood culture sticker for notes

11
How to take a blood culture(1)
  • Taking a blood culture is clinically indicated
    for this patient
  • Decontaminate blood culture bottle tops
  • Remove lids and disinfect rubber access points
    with an alcohol based disinfectant
  • 3. Carry out hand hygiene before touching the
    patient
  • Decontaminate hands before and after patient
    contact, and before applying examination gloves
  • 4. Apply alcohol based skin antiseptic and leave
    to dry
  • Patients skin is decontaminated at insertion
    site with alcohol based antiseptic and is allowed
    to dry for 30 seconds before taking the blood
    culture

12
How to take a blood culture(1)
  • 5. Dont touch critical parts
  • Open and prepare sterile equipment without
    touching critical parts. The needle/device is
    held and positioned without touching the part
    that is inserted into the patient Avoid touching
    the skin at the insertion site after disinfection
  • 6. Inoculate blood culture bottles first
  • Dispensing blood into other containers before
    the culture bottles increases the risk of
    contamination
  • 7. Document rationale, date and time of blood
    culture and operator
  • Blood culture sticker is completed and inserted
    into patient case notes

13
How to take a Blood Culture Central Site
  • Blood cultures may be taken from a central line
    using aseptic technique.
  • If investigating infection from a central line
  • Decontaminate the needle free connector using a
    compatible alcohol based antiseptic leave to
    dry for 30 seconds
  • Take a sample from a peripheral vein first to
    minimise contamination
  • Then take a sample from the central line

14
Monitoring of Practice
  • Feedback to operator if culture is contaminated
  • Sample note sticker

15
Monitoring of Blood Culture Practice
  • 2. Rate of contamination (i.e. number of
    contaminated cultures divided by the number of
    cultures taken per month)
  • 3. Audit tool of percent compliance with the
    blood culture critical elements checklist

16
References
  • NHS Quality Improvement Scotland Health
    Protection Scotland. Blood Culture Driver
    Diagram, Implementation Framework, Priority
    Elements Checklist, Data Measurement Tool and
    Measurement Plan Working Draft. Scotland NHS
    QIS/HPS. 2011 version1.1
  • Further references and bibliography can be found
    in the teaching notes
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