P-406. Implementation of an Initial Specimen Blood Culture Diversion Device to Reduce Blood Culture Contamination: Lessons Learned
Francine Touzard-Romo, Diane Auld, Alison Deabreu, Kimberly Roberts, Gail Jackson, Whitehead Valerie, Emerald O’Rourke, Phinnara Has, Leonard MermelAbstract
Background
Blood culture (BCx) contamination (BCxC) leads to unnecessary antibiotic exposure, increased hospital stay, and cost. Despite best practices, our health system’s BCxC rates remain above the 1% benchmark. Implementation of an initial specimen diversion device (ISDD) have demonstrated reduced BCxC rates. 3,4 We assessed the impact of the Kurin Lock® ISDD on BCxC and vancomycin utilization in adult emergency departments (EDs), intensive care and step-down units (ICU/SD).
Methods
The Kurin Lock® was implemented in 3 Lifespan health system hospitals (The Miriam Hospital [TMH] ED October2022; Rhode Island Hospital [RIH] and Newport Hospital [NH] EDs January 2023, and in all 3 hospital’s ICU/SD units June 2023). We included adult BCx obtained by nurses (all hospitals) or phlebotomists (NH only). BCx were drawn per protocol; growth was monitored with the BioMérieux VIRTUO System. BCxC rates were calculated dividing the number of contaminated cultures (per CDC NHSN commensal list) by the total number of BCxs/month. Mean BCxC rates prior to Kurin Lock® implementation (6 months) and after implementation (subsequent months through December 2023), excluding the month of implementation, were compared using the Wilcoxon rank-sum test. An interrupted time-series analysis was performed using binomial regression models; vancomycin days of therapy (DOT) for ’bacteremia’ was analyzed using generalized linear models.
Results
Overall mean BCxC rates for all hospitals and locations decreased from 3% to 1.9% after ISDD implementation (P=0.009). This decline was observed in all EDs but only statistically significant in RIH ICUs/SDs. In the time-series analysis, an abrupt 65% decline in BCxC was observed immediately after implementation in all hospitals and locations (P = 0.04). Lower BCxC rates were sustained after 200 days in the ICUs/SDs and 400 days in the EDs; however, an upward trend was observed with time. Vancomycin DOT was not significantly different pre- vs. post-Kurin Lock® implementation (41/1000 patient days vs. 37/1000 patient days, P=0.9).
Conclusion
A sustained decline in BCxC is achievable with the Kurin Lock® ISDD in academic and community hospital settings. But consistent education on best practices is key to guarantee the efficacy and cost-effectiveness of this intervention.
Disclosures
Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)