Document Type
DNP Project
Publication Date
5-2025
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Kerry Milner, DNSc, APRN, FNP-BC, EBP-C
Practice Mentor
Kyle Austin, MSN, RN
Second Practice Mentor
Kelly Nicholson, PhD, MPH, RN
Abstract
Background/Significance
Blood culture (BC) contamination in the Emergency Department (ED) leads to false-positive results, unnecessary antibiotic use, prolonged hospital stays, and increased healthcare costs. Contamination rates at the project site ranged from 2.2% to 6.8%, exceeding the hospital goal of <1%. Addressing this issue is critical for accurate diagnosis, effective treatment, and optimal resource utilization.
Purpose
The purpose of this project was to reduce BC contamination rates in the ED by implementing a modified BC kit, providing staff education, and conducting real-time blind audits with feedback over three months.
Methods
An evidence review, appraisal, and synthesis using Melnyk and Fineout-Overholt’s EBP process confirmed that BC kits and diversion devices are effective interventions to reduce contamination. Using the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles, the project was conducted in a 50-bed ED. The modified BC kit was introduced on October 1, 2024, and staff were educated on its use and the importance of reducing contamination rates. A knowledge check was administered post-education. From November to December 2024, 10 staff members conducted real-time blind audits of BC collection, providing immediate feedback. Data on contamination rates, staff compliance, and process measures were collected and analyzed.
Results
A total of 81% of full-time RNs and ED technicians (EDTs), 75% of part-time staff, and 67% of all RNs and EDTs were educated and achieved over 90% on the knowledge check. BC contamination rates decreased from 5.3% in September (pre-implementation) to 3.7% in October, 3.6% in November, and 2.0% in December. Audit data revealed moderate compliance with the diversion device (69% in November, 50% in December) and room for improvement in using the fill volume sticker (41% in November, 55% in December). The project achieved a return on investment of +66.6% with potential savings of $8,000 by avoiding two contaminations.
Conclusion
While the project demonstrated a reduction in BC contamination rates, further improvement is needed to meet the hospital goal of less than 1%. The use of a dedicated BC collection team could enhance compliance and sustainability. The project highlights the importance of ongoing education, real-time feedback, and staff engagement in reducing BC contamination rates and improving patient outcomes.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Maciejko, K. (2025). Improving blood culture contamination rates in the emergency department: An evidence-based quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.