This document discusses guidelines and best practices for collecting blood samples for culturing. It emphasizes that strict aseptic technique is essential to avoid contamination. Key recommendations include using trained phlebotomists, sterile single-use equipment, effective antiseptic agents with sufficient contact time on the skin, and obtaining blood cultures from a newly inserted venipuncture rather than an existing intravenous catheter. Adhering closely to protocols can help reduce the high rates of contaminated blood cultures and provide accurate diagnostic information for clinicians.

1. COLLECTING BLOOD FOR
CULTURING
principles and practice
Dr.T.V.Rao MD
4/8/2017 Dr.T.V.Rao MD @ Blood culture 1

2. 4/8/2017 Dr.T.V.Rao MD @ Blood culture 2

3. Why we culture the Blood
Physicians and clinical
microbiologists have long
appreciated that blood
cultures are perhaps the
most important laboratory
tests to diagnose serious
infections.
• Saves the lives and reducing
the infectious process if done
with precision and accuracy
4/8/2017 Dr.T.V.Rao MD @ Blood culture 3

4. 4/8/2017 Dr.T.V.Rao MD @ Blood culture 4

5. THE GREAT PROBLEM WITH
CONTAMINATION
• It has also become
apparent that
contaminated i.e., the
presence of a
pathogen from outside
the blood stream
blood cultures are
common, leading to
falsely positive test
results.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 5

6. Contamination is
the major issue
in collection
• Contaminated blood
cultures constitute as
many as half or more of
all positive blood
cultures in some
centres, are very costly
to patients and the
health care system, and
are confusing for
clinicians
4/8/2017 Dr.T.V.Rao MD @ Blood culture 6

7. Need to think on our
failures• Today much Microbiology
failed in our country
incoordination of laboratory
with clinicians, and even much
worse with upcoming teaching
hospitals leave the virtual
technique of blood collection
to most inexperience student
nurses , most important factor
is the failure of the health care
worker (HCW) to use strict
aseptic technique when
obtaining the blood specimen.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 7

8. Need for
phlebotomists
• Studies have shown that
trained phlebotomists or
blood culture teams have
fewer contaminated blood
cultures than other HCWs.
A second factor is the
antiseptic agent itself;
tincture of iodine and
chlorhexidine gluconate
are more effective at skin
sterilization than iodophor
(povidone iodine)
preparations.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 8

9. 4/8/2017 Dr.T.V.Rao MD @ Blood culture 9

10. Select equipment, prepare area
•Prepare a clean,
designated and if
possible,
dedicated area for
collecting blood
samples.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 10

11. Type of phlebotomy equipment
• Single-use, vacuum-based
phlebotomy equipment is
available to reduce the risk
of environmental
contamination.
• Safer injection devices are
increasingly available to
prevent reuse of injection
equipment and needle-stick
injuries.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 11

12. Prepare Your Hands
• Proper hygiene is essential to
safely performing venipuncture.
• Be sure to wash hands with soap
and water and dry with a clean,
single-use towel.
• Depending on workplace
procedure, you may be able to
clean hands with alcohol rub if
they are not visibly contaminated
• After cleaning your hands you
may now put on -sterile gloves.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 12

13. Select equipment,
prepare area
• Wear a new pair of gloves for each patient
• Use a sterile single-use lancet or
phlebotomy set for each patient
• Inspect packaging for breaches in
integrity
• Do not use equipment that may
not be sterile (punctured, torn or
damaged).
4/8/2017 Dr.T.V.Rao MD @ Blood culture 13

14. Locate The
Vein• With the patient's arm extended, inspect
the antecubital fossa.
• Look for a visible, good-sized vein, which
will typically be the median cubital vein.
This vein should be clearly visible before
applying the tourniquet
• Finally, apply the tourniquet 3 to 4 inches
above the venipuncture site.
• Tip: Keep in mind that opting for the
basilic vein increases the risk of damaging
a nerve or artery and is typically more
painful.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 14

15. Disinfect Site
• It's important to disinfect the site before drawing
blood to reduce the chances of contamination.
• Cleanse the site with a 70% alcohol swab by
starting from the center of the venipuncture site
and working outwards, covering roughly 2-4cms
• Be sure to allow the area to dry to reduce the risk
of contamination.
• Be sure to NOT touch the disinfected site. If site
has been touched or contaminated, repeat the
cleaning process.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 15

16. Draw Blood
Withdraw Slowly withdraw the needle and gently apply pressure to the puncture site with a clean gauze or
cotton ball. Have the patient hold the gauze or cotton on the site with their arm extended.
Release Once the blood has been collected, first release the tourniquet. Be sure to do this before
removing the needle from the vein.
Puncture Puncture the vein quickly and at a 30 degree angle or less.
Have Have the patient ball up their hand (form a fist).
Place Place your thumb BELOW the venipuncture site to anchor the vein. Be sure not to touch the
venipuncture site or you will need to repeat the cleaning process.
Perform Perform venipuncture using the following steps:
4/8/2017 Dr.T.V.Rao MD @ Blood culture 16

17. Use of Iodophors
• One step is to use more
efficacious antiseptic
preparations. Povidone
iodine preparations
(iodophors) require 1.5 to
2 minutes of contact time
to produce maximum
antiseptic effect
4/8/2017 Dr.T.V.Rao MD @ Blood culture 17

18. Chlorhexidine
gluconate is
faster
• Iodine tincture
and
chlorhexidine
gluconate only
require 30
seconds
4/8/2017 Dr.T.V.Rao MD @ Blood culture 18

19. Prepacked skin
Antiseptic Kits
• A possible benefit related to
the use of commercially
marketed pre packaged skin
antiseptic kits. However,
available data are limited,
and I believe that no firm
recommendations regarding
these prepackaged kits can
be made at this time.
4/8/2017Dr.T.V.Rao MD @ Blood culture 19

20. Caution on Interpretation of Blood
culture reports
• if only a single blood culture grows a coagulase-
negative staphylococcus, Bacillus spp., Corynebacterium
spp., Propionibacterium spp., viridans group
streptococcus, Micrococcus spp., or Aerococcus spp.,
the likelihood of contamination is high, and full
identification of the microorganism as well as
susceptibility testing should not be done unless there is
direct communication between the physician caring for
the patient and the laboratory director.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 20

21. What is recommended for disinfection
The Clinical and Laboratory Standards Institute,
a consensus organization that publishes
guidelines based on best available data,
recommends tincture of iodine, chlorine
peroxide, and chlorhexidine gluconate over
povidone-iodine and further states that iodine
tincture and chlorhexidine gluconate are
probably equivalent
4/8/2017 Dr.T.V.Rao MD @ Blood culture 21

22. Health care
workers in Hurry
• Many HCWs who obtain
blood cultures are in a hurry,
do not understand the
importance of antiseptic
contact time, and are
unlikely to wait up to 2
minutes before obtaining
blood for culture. Although
the evidence-base has
limitations
4/8/2017 Dr.T.V.Rao MD @ Blood culture 22

23. Complete the Procedure
•After sampling, minimize
bleeding by applying gentle
pressure on the sampling site
with a dry, clean cotton ball
or other similar material.
•Apply clean dressing to the
wound after bleeding has
stopped.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 23

24. Abandon collection
from Indwelling
catheters
• A third factor is the means
by which blood is obtained
for culture. In recent years,
there has been a trend
toward obtaining blood
cultures from existing
indwelling intravenous
catheters or other access
devices (e.g., ports).
4/8/2017 Dr.T.V.Rao MD @ Blood culture 24

25. MODERN CULTURE
METHODS
Modern blood culture systems
and media that incorporate
antibiotic-binding resins or
activated charcoal, while
detecting more true pathogens,
also have been shown to greatly
enhance the detection of
coagulase-negative staphylococci,
the most common blood culture
contaminants.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 25

26. Reducing
Contamination
4/8/2017 Dr.T.V.Rao MD @ Blood culture 26

27. Try with Best
efforts to reduce
Contamination
•We cannot
eliminate blood
culture
contamination
entirely, but it is
possible for
institutions to
reduce
contamination rates
4/8/2017 Dr.T.V.Rao MD @ Blood culture 27

28. Safety measures
are Increased with
HIV
• Finally, blood culture
techniques changed after
recognition that HIV is a
blood-borne pathogen. In
the pre-HIV era, the needle
used to obtain the blood
culture was removed and a
second sterile needle was
placed on the syringe for
inoculation of the blood
culture bottles.
4/8/2017 Dr.T.V.Rao MD @ Blood culture 28

29. •Program created by Dr.T.V.Rao MD for the
Benefit of Medical and Health care workers
in the developing world on matters of Hygiene
•Email
• doctortvrao@gmail.com
4/8/2017 Dr.T.V.Rao MD @ Blood culture 29