Multicenter Blood Culture Quality Improvement
Multicenter Blood Culture Quality Improvement
False positive blood culture results due to specimen contamination with bacteria inhabiting
 patients' skin is a common problem in emergency departments (EDs) in the United States.
 Contaminated blood cultures lead to patient harm through unnecessary hospitalizations and ED
 visits, delays in surgery, unneeded antibiotics, and unnecessary procedures. The
 investigators have developed a multifaceted quality improvement improvement bundle (The Blood
 Culture QI Program) designed to minimize blood culture contamination in the ED. In this
 study, the investigators will implement the quality improvement bundle in six community
 hospital EDs and evaluate its effectiveness at reducing contamination.
The Blood Culture QI Program has four components: (1) education: content knowledge and
 standardized experiential training on sterile technique designed for ED nurses; (2) process
 redesign: change in patient safety attitude and conversion of blood culture collection from a
 clean to a sterile technique; (3) checklist use: reinforcement of optimal blood culture
 collection technique at the point of care; (4) feedback: systematic charting and reporting of
 contamination rates to the ED nurses who collect cultures. In order to convert blood culture
 collection into a fully sterile procedure, the investigators developed the Sterile Blood
 Culture Collection Kit, a novel materials kit that contains the equipment needed to collect a
 culture using sterile technique, including: (1) a 3ml solution of 2% chlorhexidine gluconate
 - 70% isopropyl alcohol (Chloraprep, CareFusion) skin prep device; (2) a sterile drape; (3) a
 sterile needle; and (4) gauze.

 The investigators will evaluate the effectiveness of the Blood Culture QI Program after
 implementing it in six community hospital EDs. Our study will compromise six replications of
 an interrupted time series study wherein each replication will be powered for internal
 validity to test the hypothesis of decreasing the contamination rate by 50% at each site. A
 stepped wedge (also called multiple baseline) design will be used to implement the program
 across hospitals to evaluate the generalizability (external validity) of program
 effectiveness. The primary analysis will be an interrupted time series analysis at each site
 comparing the proportion of ED blood cultures contaminated during a post-implementation
 intervention period with a pre-intervention baseline period.
Inclusion Criteria:

 -  Patients who have a blood culture ordered for clinical purposes in one of the
 participating centers during the study period.

 Exclusion Criteria:

 -  Age < 18 years old