The infection metric hospitals need to standardize: 7 notes

Baltimore-based Johns Hopkins Medicine researchers found there is no standard definition for what constitutes contamination in a blood culture, which could lead to more false positives and CLABSI infections.

“We found variation in how hospitals define blood culture contamination, and that lack of standardization could dangerously stack the odds toward blood cultures incorrectly appearing to stay within appropriate contamination levels,” lead author Valeria Fabre, MD, associate professor of medicine in infectious diseases at the Johns Hopkins University School of Medicine, said in a Sept. 3 news release. “We did our study out of concern that with varying definitions for blood culture contamination across the country, some hospitals may rely on a definition that makes it appear they’re getting blood culture contamination rates within desired levels when in fact, they are actually higher than recommended targets and, therefore, potentially unsafe.” 

How blood culture contamination is defined can make a difference for hospitals aiming to establish quality improvement measures, the study authors said.

Here are seven things to know:

1. Blood cultures are widely used by acute care hospitals to find infections as early as possible. Contamination of blood cultures can result in false positives or inaccurate diagnoses of bacterial infections, both of which can lead to unnecessary antibiotic exposure and prolonged hospital stays.

2. Healthcare facilities try to limit contamination to less than 3% of all blood cultures done, with the optimal goal being 1% or less, in accordance with Clinical and Laboratory Standards Institute recommendations.

3. Researchers surveyed 52 acute care hospitals in 19 states and the District of Columbia and analyzed more than 360,000 blood cultures collected between Sept. 1, 2019, and Aug. 31, 2021. The study was published in the August issue of the Journal of Clinical Microbiology.

4. Of hospitals surveyed, 65.4% used blood culture contamination criteria from the Clinical and Laboratory Standards Institute or the College of American Pathologists, while 17.3% used locally defined criteria or the CAP/CLSI criteria accompanied by the comprehensive list of nonpathogenic skin surface microorganisms from the National Healthcare Safety Network.

5. About half of hospitals targeted a blood culture contamination threshold of less than 3%.

6. Researchers found only a minority of hospitals also tracked measures of blood culture quality, such as number of blood culture bottles collected and blood culture positivity. 

“This represents an important opportunity to improve the diagnosis of bloodstream infections,” Dr. Fabre said.

7. Blood culture contamination was associated with increased central line-associated bloodstream infections. For every 1% increase in the blood culture contamination rate, there was a 9% increase in CLABSIs.

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