Significant Reduction of Blood Culture Contamination in the Emergency Department (ED) Using the Steripath® Blood Diversion Device

BACKGROUND: Contaminated blood cultures are a particular problem in EDs and often lead to unnecessary antibiotic treatment. A potential approach to reduce contamination is to discard the initial aliquot of blood which is often contaminated with skin plugs and bacteria. To test this approach, we performed a study using the Steripath® (SP) device (Magnolia Medical Technologies, WA) a pre-assembled, sterile blood culture system designed to divert the initial 1.5–2.0 mls of blood prior to bottle inoculation. METHODS: This was a pre-post intervention study conducted in the ED at Rush University Medical Center, Chicago. During the pre-intervention phase (1 September to 30 November 2015), 2 sets of peripheral blood cultures were collected using standard aseptic technique by nurses in the ED. Skin antisepsis was performed with ChloraPrep® and 5–10 mls of blood was inoculated into BacT Alert SA and SN bottles (Biomerieux). During the intervention phase (1 February to 1 May 2016), blood cultures were collected using the SP device. All bottles were incubated for 5 days and rates of blood culture contamination were compared between control and intervention periods. RESULTS: Classification of blood culture contamination was based on standard CLSI criteria. During the control phase, 929 sets of blood cultures were collected in the ED. A total of 40/929 sets (4.3%) from 36 patients were identified as contaminations and 81 sets (8.7%) from 51 patients were identified as true bacteremia. The contaminants included: 29 sets (72.5%) coagulase negative Staphylococcus spp. (CoNS), 4 sets (10%) Micrococcus spp., 3 sets (7.5%) Corynebacterium spp., 2 sets (5%) alpha-hemolytic Streptococci spp., 1 set (2.5%) each Bacillus spp. and E. faecium. During the intervention phase, 3/539 (0.6%) sets of blood cultures from 3 patients were contaminated (P < 0.001). The 3 contaminants were 1 CoNS, 1 alpha-hemolytic Streptococcus spp. and 1 Corynebacterium spp. 49 sets (9.1%) from 35 patients were identified as true bacteremia. CONCLUSION: The use of the SP device in the ED over a 3-month period significantly reduced the rate of blood culture contamination from 4.3% to 0.6% while the rates of true bacteremia remain unchanged. The SP device represents a simple and effective method for reducing blood culture contamination DISCLOSURES: All authors: No reported disclosures.