Abstract:
Blood culture contamination (BCC) is a challenging issue that can negatively impact patients and healthcare costs. The Clinical and Laboratory Standards Institute (CLSI) historically encouraged a BCC rate of <3%, although recent evidence suggests <1% is achievable. One approach to reducing BCC is initial specimen blood diversion devices (ISDDs). ISDDs prevent the initial blood, which may contain contaminating microorganisms, from inoculating the blood bottles. The ISDD literature remains limited, particularly for evaluating performance across different wards. Here, the Kurin Lock ISDD was evaluated in an emergency department (ED), cardiothoracic intensive care unit (CTICU), and medical intensive care unit (MICU). A comparison of 6 months pre- and post-implementation revealed a 35.3% BCC reduction overall (P = 0.016), with variation across wards: ED 41.0% (P = 0.043), CTICU 38.7% (P = 0.20), and MICU 20.3% (P = 0.61). Device compliance rates varied by ward: ED (62.5%), CTICU (32.2%), and MICU (35.4%). When post-implementation cultures were segregated by ISDD usage, the MICU BCC rate was 0.39% versus 3.02% without ISDD usage (P = 0.025). The ED and MICU also had multiple months below 1%. The CTICU did not have a month below 1% nor a significant BCC rate difference post-implementation with or without ISDD usage (2.52% and 3.19%, P > 0.99). Furthermore, an estimated $170,378 of contamination costs were avoided using a cost per contamination of $6,553 from a prior meta-analysis. Given our low ISDD compliance, contamination rates and financial savings can still be improved. Taken together, ISDDs are a promising approach to lower BCC rates and costs, although impact may vary by ward.
Healthcare systems continue to strive toward a <1% blood culture contamination rate. Initial specimen blood diversion devices (ISDDs) are a promising approach to achieve this goal; however, data remain limited on small-volume ISDDs, especially in different hospital ward settings. Here, we found the small-volume Kurin Lock ISDD reduced blood culture contamination rates and theoretically avoided contamination costs, despite low ISDD compliance. Importantly, performance varied considerably across an emergency department and two intensive care units. While the presented findings support ISDD usage, health systems must be mindful of variable ward performance and manage expectations accordingly.
Reference:Dolin HH, Krupp AM, John AR, Cherian SS, Lewin GR, Saade EA, Ransom EM. Efficacy of a small-volume blood culture diversion device across three wards: a 6-month retrospective review. Microbiol Spectr. 2026 Jun 9:e0059326. doi: 10.1128/spectrum.00593-26. Epub ahead of print. PMID: 42262090.