Reducing blood culture contamination in emergency departments
Abstract:
Introduction: Blood culture contamination in emergency departments leads to unnecessary antibiotic use, prolonged hospital stays, and increased health care costs. Although national benchmarks recommend contamination rates of less than 3%, the Department of Veterans Affairs sets a more stringent goal of less than 1%. Many emergency departments face challenges in consistently meeting this standard. This project aimed to reduce blood culture contamination through a series of evidence-based interventions.
Methods: After a review of current literature and clinical practice guidelines and a root cause analysis to identify factors contributing to elevated rates, the team implemented a series of targeted interventions to lower contamination rates. The first phase introduced a standardized blood culture collection kit and comprehensive staff education on aseptic technique. Although initial improvements were observed, rates remained above the Department of Veterans Affairs target. In the second phase, a blood diversion device (Kurin Lock) was introduced, resulting in a further reduction in contamination rates. Finally, a remediation process was developed to support individuals identified with persistent breaches in technique for blood culture collection.
Results: The implementation of these interventions not only achieved consistency of the national benchmark rates of <3% but also led to a sustained reduction in blood culture contamination rates approaching the Department of Veterans Affairs benchmark of <1%.
Discussion: This nurse-driven quality improvement initiative demonstrates the effectiveness of structured, phased interventions in reducing blood culture contamination rates in the emergency department and highlights the critical role of nursing leadership in advancing quality and patient safety.
Reference:
Mikovich MC, Glass D, Attinato D. Reducing Blood Culture Contamination Rates in the Emergency Department: A Nurse-Driven Quality Improvement Initiative. J Emerg Nurs. 2026 Jun 9:S0099-1767(26)00158-3. doi: 10.1016/j.jen.2026.05.002. Epub ahead of print. PMID: 42268175.