A Five-Bundle Intervention to Improve Blood Culture Use in a Tertiary Hospital in Romania.

Objectives

The aims of this study were to evaluate the efficacy of a five-bundle intervention and to decrease the number of cases in which only one set of blood cultures is collected prior to starting antimicrobials.

Methods

The study group consisted of the two hospital wards that have the highest collection rate (120 blood cultures/1000 patient days and 121.4 blood cultures/1000 patient days, respectively), and the control group consisted of the other three adult wards. The collection protocol was changed, and a bundle of five measures was introduced: one-on-one discussions with the nurses, 2% chlorhexidine in 70% alcohol for disinfection, ensuring the use of sterile gloves, sterile wipes, a checklist for the materials needed, and a copy of the collection protocol. The impact of these changes was followed over a 5-month period.

Results

Prior to the intervention, the contamination rate was higher in the control group (6.5%) versus the study group (4%), p = 0.00578. The before-after analysis revealed a significantly reduced contamination rate in the control group (4.6% vs. 6.5% p = 0.0099), but it was above the one obtained in the study group (3.1% vs. 4%, p = 0.1635). The number of infectious episodes in which one blood culture set was collected decreased significantly in the study group (77/311 vs. 139/456, p = 0.041).

Conclusions

The intervention decreased the contamination rate and the number of infectious episodes in which one blood culture set is collected.