Blood culture contamination

Dr / Khalid Abokhosheim
Professor of clinical pathology- faculty of medicine
Azhar university – Cairo.Egypt
Medical lab director –children hospital Taif
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Drkhalid_Abokhosheim@Hotmail.com

 To know difference between aspiration of laboratory
samples and blood culture sample
 To know how to aspirate a correct blood culture
sample
 To know the source of contamination in blood culture
 To know the effect of contamination of blood culture
on the patient and hospital

difference between aspiration of
laboratory samples and blood
culture sample
Open discussion
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 1- Are phlebotomy routines for blood
culture different from those for other blood
samples, for instance, for chemical
analysis?
 2- How are the routines different?
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 3- Why are the routines different?
 4- Describe the disinfection routines
performed before drawing blood for
blood culture
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how to aspirate a correct blood
culture sample
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1- The doctor request for blood culture
2- The sitter inform the patient about the procedure.
3- prepare all equipment's:
- Culture bottle
- Chlorhexidine gluconate 0.5% with 70% alcohol swab or
- Chlorhexidine gluconate 0.5% swab and 70%
alcohol swab.
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- Sterile gloves
- Sterile syringes
- Sterile gauze or cotton
- Plaster
- Tourniquet
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1- Hand hygiene.
2- Position the patient.
3- Bring all the equipment bedside or procedure bed.
4- Tie tourniquet, select a vein and release the
tourniquet.
5- Select needle according to the site , blood amount
and vein characteristics.
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6- Skin preparation:
 Clean the site with an alcohol pad, moving in a
circle. Allow the alcohol to dry.
 Open Chlorhexidine applicator. Squeeze the
applicator to release the antiseptic but do not touch
the sponge.
 Scrub the site vigorously, with side to side motion,
for at least 30 seconds.
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 Allow the site to air dry for at least 30 seconds or until it
is completely dry.
- If the patient is allergic to chlorhexidine, prepare the
site with 30 second 70% alcohol scrub.
 Let the site dry and then apply tincture of iodine in a
concentric circle, starting at the center and let dry.
 If the patient is allergic to chlorhexidine and iodine,
scrub the site vigorously with 70% alcohol for 60
seconds and let dry.
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7- Do not touch the venipuncture site after it is cleaned.
8- Remove over-caps from anaerobic and aerobic
bottles and clean the top of each bottle with a
separate sterile alcohol pad.
9- Use 1 pad per bottle and allow the tops to dry for 1
minute before inoculating.
10-Alcohol pads may be left on top of the bottles while
performing the venipuncture.
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11- Check to ensure the top is dry before inoculating the
bottle. Do NOT touch the tops of the bottles.
12- again tie the tourniquet. Do not allow it to touch the
cleaned site. If the cleaned site is touched, the area
has to be re-prepped.
13- wear a sterile gloves.
14 - You may palpate the vein with the sterile gloves.
ONLY if you have not touched a non-sterile item or
surface.
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AGE or weight of baby DRAW VOLUME
Less than 1500g 0.5 mL
More than 1500g 0.5 – 1mL
Up to 1 year 1 mL
1 plus years 1 mL per year of age
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16- Change the needle with fresh sterile one then
inject the required blood in each culture bottle.
Inspect the culture bottle for any turbidity before
inoculation with blood, if present, discard it.
17- Do not allow the blood to clot before or after
being added to the culture bottle as this will entrap
bacteria in clot inhibiting it from being grown.
18- Do not allow air to enter bottle. Invert to mix.
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A- THE PATIENT , EQUIPMENT AND NURSE
 Put pressure on the venipuncture site with sterile gauze or
cotton.
 Place patient in comfortable position.
 Discard used equipment according to hospital protocol.
 Remove gloves. Do hand hygiene.
 Complete the microbiology requisition.
 Clean the outside of the specimen containers if contaminated
with blood.
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B- THE BLOOD CULTURE
 Label the bottles in the presence of the patient. Record the
time, collection site, and your initials on the requisition.
 Place specimens in biohazard container.
 Immediate transport to lab is recommended.
 Do not refrigerate specimen. Incubate at 37ºC or room
temperature.
 Protect from direct sunlight or extremes of temperature.

source of contamination in
blood culture
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 It considered contaminated if one of the following
organisms was present in 50% of all blood culture
sets obtained from one department on the same
day:
 coagulase-negative staphylococci, alpha-hemolytic
streptococci, Micrococcus species, Propionibacterium
species, Corynebacterium species, and Bacillus
species.
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 stressful working environment,
 impractical phlebotomy guidelines
 lack of information and feedback
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 1- do not hurry
 2- carefully disinfect the skin at the phlebotomy
site for 2 min.
 3- Do not touch puncture side with your finger
 4- carefully disinfect the culture bottle
 5- change needle before inoculation

The effect of contamination of
blood culture on the patient
and hospital

Exposure or Unnecessary use of antibiotics can
lead to multidrug resistant organisms
false-positive results can cause confusion
regarding antibiotic regimens, endangering patient
safety
 Additional diagnostic testing to the patient
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Prolonged hospital stay or unnecessary
admission
 Increased costs and utilization of resources and
patient care
 Decreases the positive predictive value of the
blood culture system
increase laboratory work

 1- Nursing skill can make a difference in
contamination rates
 2- Feedback on nursing practice to the nurse is
important for lowering contamination rates.
 3- The department’s contamination rates were compared
to that of the whole hospital
 4- Contamination of blood cultures may be very costly,
not only for the laboratory but also for other clinics.
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Blood culture contamination

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