Impact of educationl interventions on the quality of blood culture specimens

ABSTRACT

Blood cultures [BC] are among the most important specimens for detection of etiologic agents in severe infections. At Salmaniya Medical Complex [SMC], the number of BCs increased from 10580 in 2002 to 13123 for 2004. The specimens likely to be contaminated averages 4.5 percent of the total BC processed with consumption of human and financial resources. We assessed the impact of an educational intervention aimed at decreasing false positivity to internationally accepted levels [<3 percent]. During October-November 2004, BC received at the Microbiology Laboratory at SMC were examined for appropriateness. During the ensuing two investigational months [December 2004- January 2005] an educational intervention was carried out which included phone calls, personal visits in the Wards, practical and theoretical sessions with the health care workers, distribution of Guidelines and attachment of online messages to reports. In the post-intervention period [February -March 2005], the appropriateness parameters were reassessed. Fifty-nine percent of BC received was inappropriate with no significant changes before and after the educational intervention. Although we were able to decrease the number of volume-appropriate bottles likely contaminated and reduce the number of cultures likely contaminated, the figures were still above the international benchmark value. We observed an increase in the number of bottles containing less than the minimal requirement of 3ml of blood. Education per se is not effective in reducing contamination and costs. To succeed the best approach will be to rely on dedicated phlebotomists team which can be a cost effective solution saving between USD720,00 and 1.3 million annually