Taming the contaminants: a quality improvement initiative to minimize blood culture contamination and enhance patient care in a resource-limited setting.

BACKGROUND: Blood culture contamination (BCC) in hospitals negatively impacts patient outcomes. Theobjective of this study is to reduce the mean BCC rate at the Peshawar Institute of Cardiology-MTI from a baseline to below the international benchmark of 3%. This will be achieved through a prospective interventional quality improvement project utilizing the Plan-Do-Study-Act (PDSA) cycle, specifically focusing on "hardened" aseptic protocols, "Master Trainer" mentorship, and the institutionalization of BCC as a Key Performance Indicator (KPI).

METHODS: This interventional study at our tertiary care setup in Peshawar, Pakistan, from December 2024 to December 2025, included all blood cultures. The study period was divided into a 6-month pre-intervention baseline and a 7-month intervention period with monthly BCC monitoring. Interventions included regular training, didactic sessions, and re-competencies. Laboratory personnel monitored BCC rates, reported findings, and provided feedback. BCC rate calculation followed pre-set criteria specific to our institution.

RESULTS: Across all hospital departments, we received 646 blood cultures, with 285 collected during the pre-intervention phase and 361 during the intervention. The mean BCC rate significantly decreased from 12.9% in the pre-intervention period to 6.09% by the end of the intervention. Notably, the majority of blood cultures originated from inpatient units (83.06%), and 62.7% of all contaminations were reported in male patients.

CONCLUSION: A simple intervention effectively lowered BCC in our setting, particularly addressing inpatient factors. However, without observational audits, pinpointing specific causes remains challenging. Future research should focus on targeted strategies for sustained improvements.