Question

The microbiology manager has noticed a significant increase in contaminated blood cultures this month.

Contamination occurs due to improper phlebotomy technique (i.e., not thoroughly cleaning the puncture site prior to specimen collection) allowing skin flora to enter the culture bottle. This can result in the patient being prescribed antibiotics that are not needed. Their hospital stay may also be extended in order to r/o sepsis.

Blood cultures are collected by phlebotomists from the laboratory and by nurses on the floors.

You are the Allied Health and Nursing Education Coordinator for the hospital.

Use the PDCA tool to develop a plan of action that will help decrease the number of contaminated cultures.

Answer 1

PDCA TOOL

PLAN-

Blood culture is one of the important determinant of infection residing in the blood stream. contaminated blood culture can increase the patient ALOS (Average length of stay), unneccesary prescription of antibiotics and incurred cost associated with this. It was found that Infection control practices were not followed during sample collection.that lead to contamination of blood culture in the samples.

DO :

Project Name: BREAK THE GERM CYCLE

Project Goal: To develop and implement prevention bundle checklist to prevent contamainated blood cultures during blood culture sample collection process.

IMPLEMENTATION

Measures to be taken to prevent further occurence of infections in patient

• Practice good hand hygeine before collection of sample
• Use of disinfectant for cleaning the site with large cpncentric circles and disinfectant should remain in contact with skin for 1 minute or until allow it to dry
• Use of sterile gloves and sterile sheet during sample collection procedure
• The venepuncture site must be palpated after the skin preparation
• Cleanse the bottle with disinfectant
• Sending of blood sample with proper label with in the time frame

CHECK

• All these measures implemented for 1 month in the no. of patients (sample-20) for 1 month for blood culture sample process
• Infection rates were drastically decreased after successful implementation of the prevention strategies

ACT

• These prevention strategies were standarized as per WHO Aand CDC guidelines.
• Prevention bundle checklist was developed and introduced
• Blood culture sampling process was done as per checklist
• Staff Training and Education was conducted for successful implementation of the programme and to maintain sustainability