Title : Blood culture contamination in the ED: A practice improvement project
Abstract:
Background: Contaminated blood cultures are a persistent issue in emergency departments, often resulting in unnecessary antibiotic use, prolonged hospital stays, and increased healthcare costs. Despite existing protocols, inconsistent adherence to proper collection techniques contributes to elevated contamination rates. This project was implemented in a high-volume emergency department in Northwest Florida that had consistently reported blood culture contamination rates exceeding the accepted benchmark of 3%.
Purpose: The purpose of this practice change project was to implement a bundled educational intervention focused on standardized blood culture collection techniques and evaluate its effect on contamination rates in the emergency department setting.
Methods: Using a pre-post intervention design, this project included an educational bundle delivered over a four- week period. The intervention featured a policy review, online module with demonstration video, best practices huddle card, FAQ handout, and one-hour in-person simulation training with return demonstration. All ED nursing staff (n = 95) were included. Data on contamination rates were collected four weeks before and four weeks after the intervention. Chi-square tests were used to analyze differences in contamination rates overall and by staff participation level.
Results: The overall contamination rate decreased from 6.2% pre-intervention to 5.0% post-intervention, but this change was not statistically significant. However, contamination rates varied significantly by participation level in the training (χ²(4, N = 1,582) = 48.61, p < .001). Nurses who completed both the online and live training had the lowest contamination rate at 2.8%, compared to 5.5% (online only), 7.9% (live only), and 20.2% (no participation). These findings suggest that full engagement with the educational intervention was associated with improved adherence to best practices and reduced contamination rates.
Implications for Practice: This project highlights the importance of combining standardized education with hands-on simulation and feedback to improve clinical practice. Although the overall change in contamination rates was not statistically significant, the strong correlation between training completion and improved outcomes demonstrates the value of multi-modal education. The bundled approach, grounded in evidence-based strategies and supported by leadership engagement, can be replicated across departments to enhance practice consistency, reduce unnecessary interventions, and improve patient safety. Future efforts should focus on early assignment of training, mandatory participation tracking, and sustained reinforcement to support long-term adoption of best practices in blood culture collection.
