From BI in NYC- cost of false positive and rates of true pos in ambulatory setting
", "tags": [], "relations": {}, "dateAdded": "2015-01-16T19:03:45Z", "dateModified": "2015-01-16T19:04:43Z" } }, { "key": "WFGWDQ3I", "version": 16, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/WFGWDQ3I", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/WFGWDQ3I", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/SWD9F37D", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "WFGWDQ3I", "version": 16, "parentItem": "SWD9F37D", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T19:03:35Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/8853672", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T19:03:35Z", "dateModified": "2015-01-16T19:03:35Z" } }, { "key": "SWD9F37D", "version": 16, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/SWD9F37D", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/SWD9F37D", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Sturmann et al.", "parsedDate": "1996-08", "numChildren": 2 }, "data": { "key": "SWD9F37D", "version": 16, "itemType": "journalArticle", "title": "Blood cultures in adult patients released from an urban emergency department: a 15-month experience", "creators": [ { "creatorType": "author", "firstName": "K. M.", "lastName": "Sturmann" }, { "creatorType": "author", "firstName": "J.", "lastName": "Bopp" }, { "creatorType": "author", "firstName": "D.", "lastName": "Molinari" }, { "creatorType": "author", "firstName": "S.", "lastName": "Akhtar" }, { "creatorType": "author", "firstName": "J.", "lastName": "Murphy" } ], "abstractNote": "OBJECTIVE: To determine the frequency of positive blood cultures obtained from adult patients with potential occult bacteremia released from an urban ED and how often these positive cultures alter the subsequent patient course or management.\nMETHODS: This retrospective case series study was conducted at the ED of a large, urban teaching hospital. The study population consisted of a convenience sample of adult patients who presented to the ED with evidence of fever or other clinical conditions suggesting the possibility of bacteremia. The records of all patients who had blood cultures done and who were not admitted to an inpatient service were reviewed. Follow-up was obtained for all patients for whom culture results were positive. A substantial influence on the medical management or clinical course by a (noncontaminant) positive blood culture result was defined as a positive result that directly led to: further diagnostic testing, hospital admission, initiation or alteration of antibiotic therapy, or a different diagnosis. Culture-positive patients who were noncompliant with requested ED follow-up were included in this estimate. An estimate of the laboratory charges per diagnosis of bacteremia also was derived.\nRESULTS: Only 24 of 1,350 patients (1.8% of the study population; 95% CI 1.1-2.5%) had true-positive blood cultures. Only 7 patients (0.52% of the population; 95% CI 0.14-0.90%) potentially had their medical management affected by the positive blood culture results. Based on the laboratory charges associated with all blood cultures for this patient group, the cost per clinically significant positive blood culture result was $ 11,570.\nCONCLUSIONS: The prevalence of bacteremia was 1.8% among the released patients who had blood cultures obtained in the ED. Furthermore, only 0.52% of the patients had positive blood cultures that potentially affected their medical management. Further study is warranted to identify specific criteria for selecting ambulatory patients for whom the use of blood cultures may be cost-effective.", "publicationTitle": "Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine", "publisher": "", "place": "", "date": "Aug 1996", "volume": "3", "issue": "8", "section": "", "partNumber": "", "partTitle": "", "pages": "768-775", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Acad Emerg Med", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1069-6563", "archive": "", "archiveLocation": "", "shortTitle": "Blood cultures in adult patients released from an urban emergency department", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 8853672", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Bacteremia", "type": 1 }, { "tag": "Bacteriological Techniques", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Hospitals, Teaching", "type": 1 }, { "tag": "Hospitals, Urban", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Incidence", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "New York City", "type": 1 }, { "tag": "Process Assessment (Health Care)", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T19:03:35Z", "dateModified": "2015-01-16T19:03:35Z" } }, { "key": "HSW4S6MF", "version": 15, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/HSW4S6MF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/HSW4S6MF", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/HJ8GA8R8", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "HSW4S6MF", "version": 15, "parentItem": "HJ8GA8R8", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T19:01:17Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21216032", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T19:01:17Z", "dateModified": "2015-01-16T19:01:17Z" } }, { "key": "HJ8GA8R8", "version": 15, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/HJ8GA8R8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/HJ8GA8R8", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Alahmadi et al.", "parsedDate": "2011-03", "numChildren": 1 }, "data": { "key": "HJ8GA8R8", "version": 15, "itemType": "journalArticle", "title": "Clinical and economic impact of contaminated blood cultures within the hospital setting", "creators": [ { "creatorType": "author", "firstName": "Y. M.", "lastName": "Alahmadi" }, { "creatorType": "author", "firstName": "M. A.", "lastName": "Aldeyab" }, { "creatorType": "author", "firstName": "J. C.", "lastName": "McElnay" }, { "creatorType": "author", "firstName": "M. G.", "lastName": "Scott" }, { "creatorType": "author", "firstName": "F. W.", "lastName": "Darwish Elhajji" }, { "creatorType": "author", "firstName": "F. A.", "lastName": "Magee" }, { "creatorType": "author", "firstName": "M.", "lastName": "Dowds" }, { "creatorType": "author", "firstName": "C.", "lastName": "Edwards" }, { "creatorType": "author", "firstName": "L.", "lastName": "Fullerton" }, { "creatorType": "author", "firstName": "A.", "lastName": "Tate" }, { "creatorType": "author", "firstName": "M. P.", "lastName": "Kearney" } ], "abstractNote": "Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P<0.001] and £5,001.5 [$7,502.2; 95% CI: £3,283.9 ($4,925.8) to £6,719.1 ($10,078.6); P<0.001], respectively. Consequently, and considering that 254 false-positive blood cultures had occurred in the study site hospital over a one-year period, patients with false-positive blood cultures added 1372 extra hospital days and incurred detrimental additional hospital costs of £1,270,381 ($1,905,572) per year. The findings therefore demonstrate that false-positive blood cultures have a significant impact on increasing hospital length of stay, laboratory and pharmacy costs. These findings highlight the need to intervene to raise the standard of blood-culture-taking technique, thus improving both the quality of patient care and resource use.", "publicationTitle": "The Journal of Hospital Infection", "publisher": "", "place": "", "date": "Mar 2011", "volume": "77", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "233-236", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J. Hosp. Infect.", "DOI": "10.1016/j.jhin.2010.09.033", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1532-2939", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21216032", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Bacteriological Techniques", "type": 1 }, { "tag": "Blood", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Case-Control Studies", "type": 1 }, { "tag": "Cost-Benefit Analysis", "type": 1 }, { "tag": "Cross Infection", "type": 1 }, { "tag": "Culture Media", "type": 1 }, { "tag": "Equipment Contamination", "type": 1 }, { "tag": "False Positive Reactions", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Hospital Costs", "type": 1 }, { "tag": "Hospitals", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Length of Stay", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Young Adult", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T19:01:17Z", "dateModified": "2015-01-16T19:01:17Z" } }, { "key": "6RWR8KGR", "version": 14, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/6RWR8KGR", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/6RWR8KGR", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/UCDKG2QN", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "6RWR8KGR", "version": 14, "parentItem": "UCDKG2QN", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:12:44Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/9041389", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:12:44Z", "dateModified": "2015-01-16T18:12:44Z" } }, { "key": "UCDKG2QN", "version": 14, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/UCDKG2QN", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/UCDKG2QN", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Weinbaum et al.", "parsedDate": "1997-03", "numChildren": 1 }, "data": { "key": "UCDKG2QN", "version": 14, "itemType": "journalArticle", "title": "Doing it right the first time: quality improvement and the contaminant blood culture", "creators": [ { "creatorType": "author", "firstName": "F. I.", "lastName": "Weinbaum" }, { "creatorType": "author", "firstName": "S.", "lastName": "Lavie" }, { "creatorType": "author", "firstName": "M.", "lastName": "Danek" }, { "creatorType": "author", "firstName": "D.", "lastName": "Sixsmith" }, { "creatorType": "author", "firstName": "G. F.", "lastName": "Heinrich" }, { "creatorType": "author", "firstName": "S. S.", "lastName": "Mills" } ], "abstractNote": "The aim of the project was to determine whether the rate of contaminant blood cultures could be reduced by using a team of dedicated phlebotomists. Comparisons were made between adult patients requiring blood cultures for suspected bacteremia on medical and surgical units before and after the introduction and withdrawal of a dedicated blood culture team. The results showed that a significant reduction in the contaminant blood culture rate was achieved by the blood culture team (P < 0.001; chi(2) test). Therefore, in our experience, the rate of contaminant blood cultures can be reduced in a teaching hospital by using a team of dedicated phlebotomists. Calculations made with our data and those published by others suggest that cost savings from reducing false-positive blood cultures are greater than the cost of the blood culture team.", "publicationTitle": "Journal of Clinical Microbiology", "publisher": "", "place": "", "date": "Mar 1997", "volume": "35", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "563-565", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J. Clin. Microbiol.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0095-1137", "archive": "", "archiveLocation": "", "shortTitle": "Doing it right the first time", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 9041389 \nPMCID: PMC229627", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Bacteremia", "type": 1 }, { "tag": "Bacteriological Techniques", "type": 1 }, { "tag": "Blood", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Cost-Benefit Analysis", "type": 1 }, { "tag": "Evaluation Studies as Topic", "type": 1 }, { "tag": "False Positive Reactions", "type": 1 }, { "tag": "Hospitals, Teaching", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Internship and Residency", "type": 1 }, { "tag": "Phlebotomy", "type": 1 }, { "tag": "Quality Control", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:12:44Z", "dateModified": "2015-01-16T18:12:44Z" } }, { "key": "FME4KTUA", "version": 12, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/FME4KTUA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/FME4KTUA", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/IIA36W7N", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "FME4KTUA", "version": 12, "parentItem": "IIA36W7N", "itemType": "note", "note": "educational intervention aimed ad physicians rather than nursing or phlebotomists and had decrease in contamination rates
", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:11:09Z", "dateModified": "2015-01-16T18:11:35Z" } }, { "key": "IIA36W7N", "version": 11, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/IIA36W7N", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/IIA36W7N", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Eskira et al.", "parsedDate": "2006-08", "numChildren": 2 }, "data": { "key": "IIA36W7N", "version": 11, "itemType": "journalArticle", "title": "Reduction of blood culture contamination rate by an educational intervention", "creators": [ { "creatorType": "author", "firstName": "S.", "lastName": "Eskira" }, { "creatorType": "author", "firstName": "J.", "lastName": "Gilad" }, { "creatorType": "author", "firstName": "P.", "lastName": "Schlaeffer" }, { "creatorType": "author", "firstName": "E.", "lastName": "Hyam" }, { "creatorType": "author", "firstName": "N.", "lastName": "Peled" }, { "creatorType": "author", "firstName": "I.", "lastName": "Karakis" }, { "creatorType": "author", "firstName": "K.", "lastName": "Riesenberg" }, { "creatorType": "author", "firstName": "F.", "lastName": "Schlaeffer" }, { "creatorType": "author", "firstName": "A.", "lastName": "Borer" } ], "abstractNote": "The efficacy of an educational intervention to prevent blood culture contamination (BCC) in internal medicine was studied in two medical wards in a busy tertiary-care hospital in which blood cultures were obtained by physicians rather than dedicated phlebotomists. Baseline BCC rates were 5.7% and 7.1% in intervention and control wards, respectively (p 0.6), compared with 1.95% and 6.7%, respectively, post-intervention (p < 0.001). Following multivariate analysis, only an absence of intervention was an independent variable associated with BCC. Thus simple educational intervention reduced BCC in internal medicine and was considered to be cost-effective.", "publicationTitle": "Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases", "publisher": "", "place": "", "date": "Aug 2006", "volume": "12", "issue": "8", "section": "", "partNumber": "", "partTitle": "", "pages": "818-821", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Clin. Microbiol. Infect.", "DOI": "10.1111/j.1469-0691.2006.01446.x", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1198-743X", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 16842584", "tags": [ { "tag": "Bacteremia", "type": 1 }, { "tag": "Blood", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Cycloheximide", "type": 1 }, { "tag": "Disinfection", "type": 1 }, { "tag": "Equipment Contamination", "type": 1 }, { "tag": "Ethanol", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Skin", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:11:05Z", "dateModified": "2015-01-16T18:11:05Z" } }, { "key": "CUIWCF7E", "version": 11, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/CUIWCF7E", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/CUIWCF7E", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/IIA36W7N", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "CUIWCF7E", "version": 11, "parentItem": "IIA36W7N", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:11:05Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/16842584", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:11:05Z", "dateModified": "2015-01-16T18:11:05Z" } }, { "key": "AWG48ARI", "version": 11, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/AWG48ARI", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/AWG48ARI", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/7B54PNZ3", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "AWG48ARI", "version": 11, "parentItem": "7B54PNZ3", "itemType": "note", "note": "refutes another study that says contamination is higher when drawing cultures off of fresh IV sites
", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:09:37Z", "dateModified": "2015-01-16T18:10:32Z" } }, { "key": "7B54PNZ3", "version": 11, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/7B54PNZ3", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/7B54PNZ3", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Smart et al.", "parsedDate": "1993-07", "numChildren": 2 }, "data": { "key": "7B54PNZ3", "version": 11, "itemType": "journalArticle", "title": "Effect of needle changing and intravenous cannula collection on blood culture contamination rates", "creators": [ { "creatorType": "author", "firstName": "D.", "lastName": "Smart" }, { "creatorType": "author", "firstName": "C.", "lastName": "Baggoley" }, { "creatorType": "author", "firstName": "J.", "lastName": "Head" }, { "creatorType": "author", "firstName": "D.", "lastName": "Noble" }, { "creatorType": "author", "firstName": "B.", "lastName": "Wetherall" }, { "creatorType": "author", "firstName": "D. L.", "lastName": "Gordon" } ], "abstractNote": "STUDY OBJECTIVES: We tested the hypotheses that blood culture positivity and contamination rates were not increased by not changing needles between venipuncture and inoculation of blood culture bottles or by taking blood for culture by freshly inserted IV cannulae.\nDESIGN: A prospective study of blood cultures collected by venipuncture or IV cannulae taken from an emergency department population. Venipuncture samples were randomized into needle change (standard method) or no needle change before inoculation into blood culture bottles.\nPARTICIPANTS: Nine hundred forty patients requiring blood cultures after assessment in the ED.\nINTERVENTIONS: A standard disinfection procedure using 0.5% chlorhexidine in 70% alcohol was used. Blood was collected by venipuncture and inoculated with or without needle change. Blood collected by IV cannula was inoculated with a fresh needle applied to the collection syringe.\nMEASUREMENTS AND MAIN RESULTS: There was no statistically significant difference in contamination rates for blood collected by venipuncture with no needle change (6.4%) compared with needle change (4.2%, P > .30). No significant difference in contamination rates was noted for blood taken by freshly inserted IV cannulae (4.3%) compared with venipuncture with needle change after sampling (4.2%, P > .90). Some problems with randomization resulted in unequal numbers in the needle-change (286) versus no-needle-change (141) subgroups, and this may have introduced bias. A higher rate of pathogen growth was observed in blood taken by IV cannula (11.4%) compared with the standard method (6.3%) (P < .025). A significantly greater rate of Gram-negative sepsis was noted in the IV cannula group (6.6%) compared with direct venipuncture with needle change (1.1%) and no needle change (4.2%, P < .01).\nCONCLUSION: The results of this study do not support the practice of changing needles before inoculating blood samples into blood culture bottles. Collection of blood for culture through freshly inserted IV cannulae is associated with a low contamination rate and is an acceptable alternative to direct venipuncture. Sources of bias in this study suggest that further research is needed to determine the optimal technique for collecting blood cultures.", "publicationTitle": "Annals of Emergency Medicine", "publisher": "", "place": "", "date": "Jul 1993", "volume": "22", "issue": "7", "section": "", "partNumber": "", "partTitle": "", "pages": "1164-1168", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0196-0644", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 8517568", "tags": [ { "tag": "Bacteriological Techniques", "type": 1 }, { "tag": "Blood", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Catheters, Indwelling", "type": 1 }, { "tag": "Equipment Contamination", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Needles", "type": 1 }, { "tag": "Prospective Studies", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:09:27Z", "dateModified": "2015-01-16T18:09:27Z" } }, { "key": "97VCAHV7", "version": 11, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/97VCAHV7", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/97VCAHV7", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/7B54PNZ3", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "97VCAHV7", "version": 11, "parentItem": "7B54PNZ3", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:09:27Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/8517568", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:09:27Z", "dateModified": "2015-01-16T18:09:27Z" } }, { "key": "BD8SMKX8", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/BD8SMKX8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/BD8SMKX8", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/DJK4HS7S", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "BD8SMKX8", "version": 10, "parentItem": "DJK4HS7S", "itemType": "note", "note": "Advocates for phlebotomy teams and sterile technique, but I think we can achieve similar results with out all of that. Might be a good study in the future and good background material
", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:07:25Z", "dateModified": "2015-01-16T18:08:50Z" } }, { "key": "DJK4HS7S", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/DJK4HS7S", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/DJK4HS7S", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Self et al.", "parsedDate": "2014-08", "numChildren": 2 }, "data": { "key": "DJK4HS7S", "version": 10, "itemType": "journalArticle", "title": "Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams", "creators": [ { "creatorType": "author", "firstName": "Wesley H.", "lastName": "Self" }, { "creatorType": "author", "firstName": "Thomas R.", "lastName": "Talbot" }, { "creatorType": "author", "firstName": "Barbara R.", "lastName": "Paul" }, { "creatorType": "author", "firstName": "Sean P.", "lastName": "Collins" }, { "creatorType": "author", "firstName": "Michael J.", "lastName": "Ward" } ], "abstractNote": "OBJECTIVE: Blood culture collection practices that reduce contamination, such as sterile blood culture collection kits and phlebotomy teams, increase up-front costs for collecting cultures but may lead to net savings by eliminating downstream costs associated with contamination. The study objective was to compare overall hospital costs associated with 3 collection strategies: usual care, sterile kits, and phlebotomy teams.\nDESIGN: Cost analysis.\nSETTING: This analysis was conducted from the perspective of a hospital leadership team selecting a blood culture collection strategy for an adult emergency department (ED) with 8,000 cultures drawn annually.\nMETHODS: Total hospital costs associated with 3 strategies were compared: (1) usual care, with nurses collecting cultures without a standardized protocol; (2) sterile kits, with nurses using a dedicated sterile collection kit; and (3) phlebotomy teams, with cultures collected by laboratory-based phlebotomists. In the base case, contamination rates associated with usual care, sterile kits, and phlebotomy teams were assumed to be 4.34%, 1.68%, and 1.10%, respectively. Total hospital costs included costs of collecting cultures and hospitalization costs according to culture results (negative, true positive, and contaminated).\nRESULTS: Compared with usual care, annual net savings using the sterile kit and phlebotomy team strategies were $483,219 and $288,980, respectively. Both strategies remained less costly than usual care across a broad range of sensitivity analyses.\nCONCLUSIONS: EDs with high blood culture contamination rates should strongly consider evidence-based strategies to reduce contamination. In addition to improving quality, implementing a sterile collection kit or phlebotomy team strategy is likely to result in net cost savings.", "publicationTitle": "Infection Control and Hospital Epidemiology: The Official Journal of the Society of Hospital Epidemiologists of America", "publisher": "", "place": "", "date": "Aug 2014", "volume": "35", "issue": "8", "section": "", "partNumber": "", "partTitle": "", "pages": "1021-1028", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Infect Control Hosp Epidemiol", "DOI": "10.1086/677161", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1559-6834", "archive": "", "archiveLocation": "", "shortTitle": "Cost analysis of strategies to reduce blood culture contamination in the emergency department", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 25026619 \nPMCID: PMC4100213", "tags": [], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:07:06Z", "dateModified": "2015-01-16T18:07:06Z" } }, { "key": "BXH7WEEW", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/BXH7WEEW", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/BXH7WEEW", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/DJK4HS7S", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "BXH7WEEW", "version": 10, "parentItem": "DJK4HS7S", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:07:06Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/25026619", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:07:06Z", "dateModified": "2015-01-16T18:07:06Z" } }, { "key": "B6ZCWPTD", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/B6ZCWPTD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/B6ZCWPTD", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/D8UNSRQE", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "B6ZCWPTD", "version": 10, "parentItem": "D8UNSRQE", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:06:31Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/18562871", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:06:31Z", "dateModified": "2015-01-16T18:06:31Z" } }, { "key": "D8UNSRQE", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/D8UNSRQE", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/D8UNSRQE", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Tepus et al.", "parsedDate": "2008-09", "numChildren": 1 }, "data": { "key": "D8UNSRQE", "version": 10, "itemType": "journalArticle", "title": "Effectiveness of Chloraprep in reduction of blood culture contamination rates in emergency department", "creators": [ { "creatorType": "author", "firstName": "Dwayne", "lastName": "Tepus" }, { "creatorType": "author", "firstName": "Eileen", "lastName": "Fleming" }, { "creatorType": "author", "firstName": "Sandy", "lastName": "Cox" }, { "creatorType": "author", "firstName": "Susan", "lastName": "Hazelett" }, { "creatorType": "author", "firstName": "Denise", "lastName": "Kropp" } ], "abstractNote": "Contaminated blood cultures result in increased healthcare utilization. Poor skin preparation is usually the cause of contamination. Our study results showed a significant decrease in contamination rates using 2% chlorhexidine and 70% isopropanol (Chloraprep) versus tincture of iodine. Adoption of this technique throughout our institution is expected to result in a savings of 875000 dollars per year, as well as decreased discomfort for the patient.", "publicationTitle": "Journal of Nursing Care Quality", "publisher": "", "place": "", "date": "2008 Jul-Sep", "volume": "23", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "272-276", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Nurs Care Qual", "DOI": "10.1097/01.NCQ.0000324593.84213.4f", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1057-3631", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 18562871", "tags": [ { "tag": "2-Propanol", "type": 1 }, { "tag": "Administration, Cutaneous", "type": 1 }, { "tag": "Anti-Infective Agents, Local", "type": 1 }, { "tag": "Antisepsis", "type": 1 }, { "tag": "Benchmarking", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Chlorhexidine", "type": 1 }, { "tag": "Clinical Nursing Research", "type": 1 }, { "tag": "Cost Savings", "type": 1 }, { "tag": "Drug Combinations", "type": 1 }, { "tag": "Emergency Nursing", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Iodine", "type": 1 }, { "tag": "Ohio", "type": 1 }, { "tag": "Skin", "type": 1 }, { "tag": "Skin Care", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:06:31Z", "dateModified": "2015-01-16T18:06:31Z" } }, { "key": "I6TPT9TQ", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/I6TPT9TQ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/I6TPT9TQ", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/4VV7E9Q8", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } } }, "data": { "key": "I6TPT9TQ", "version": 10, "parentItem": "4VV7E9Q8", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2015-01-16T18:05:58Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/19348119", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2015-01-16T18:05:58Z", "dateModified": "2015-01-16T18:05:58Z" } }, { "key": "4VV7E9Q8", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/4VV7E9Q8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/4VV7E9Q8", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "creatorSummary": "Bamber et al.", "parsedDate": "2009", "numChildren": 1 }, "data": { "key": "4VV7E9Q8", "version": 10, "itemType": "journalArticle", "title": "Effectiveness of introducing blood culture collection packs to reduce contamination rates", "creators": [ { "creatorType": "author", "firstName": "A. I.", "lastName": "Bamber" }, { "creatorType": "author", "firstName": "J. G.", "lastName": "Cunniffe" }, { "creatorType": "author", "firstName": "D.", "lastName": "Nayar" }, { "creatorType": "author", "firstName": "R.", "lastName": "Ganguly" }, { "creatorType": "author", "firstName": "E.", "lastName": "Falconer" } ], "abstractNote": "Contaminated blood cultures result in a significant waste of healthcare resources and can lead to inappropriate antibiotic therapy. Practitioners have taken measures to reduce contamination rates. These include thorough skin disinfection, effective hand decontamination, introduction of a standardised approach to collection, and the introduction of blood culture collection packs (BCCP). This study aims to assess the impact of introducing BCCP and staff training on the rate of contamination. The study demonstrated that contamination rates are greatest in high patient throughput units where practitioners are under most pressure. The introduction of blood culture packs and staff training has reduced contamination rate significantly from 43% to 25% of the total number of positives, equating to an overall reduction of 42%. Thus, there is a demonstrable benefit in the purchase of commercially produced blood culture packs and the investment in staff training.", "publicationTitle": "British Journal of Biomedical Science", "publisher": "", "place": "", "date": "2009", "volume": "66", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "6-9", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Br. J. Biomed. Sci.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0967-4845", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 19348119", "tags": [ { "tag": "Blood", "type": 1 }, { "tag": "Blood Specimen Collection", "type": 1 }, { "tag": "Clinical Competence", "type": 1 }, { "tag": "Disposable Equipment", "type": 1 }, { "tag": "Equipment Contamination", "type": 1 }, { "tag": "False Positive Reactions", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Inservice Training", "type": 1 }, { "tag": "Skin", "type": 1 }, { "tag": "Staphylococcus", "type": 1 } ], "collections": [ "8KUVF3Z2" ], "relations": {}, "dateAdded": "2015-01-16T18:05:58Z", "dateModified": "2015-01-16T18:05:58Z" } }, { "key": "3X59BCS4", "version": 10, "library": { "type": "group", "id": 320164, "name": "QI Projects", "links": { "alternate": { "href": "https://www.zotero.org/groups/qi_projects", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/320164/items/3X59BCS4", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/qi_projects/items/3X59BCS4", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/320164/items/KZPN7M8I", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1089642, "username": "scha4jm", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/scha4jm", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "3X59BCS4", "version": 10, "parentItem": "KZPN7M8I", "itemType": "note", "note": "Describes nursing interventions similar to what we are doing, Lots of references that I haven't sifted through
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