New ASCP Blood Culture Collection Training Aims to Reduce Errors, Improve Quality

Ensuring blood collection is properly done might seem straightforward. Yet, mistakes still occur, and they present a big problem in healthcare systems.

“Blood culture contamination is not new,” says Sachin Gupta, PhD, MBA, MT(ASCPⁱ)MB, LSSBB, CPHQ, Scientific Director of the ASCP Center for Quality and Patient Safety. “Any false positive blood culture can lead to a delay in diagnosis, unnecessary treatment, and possibly a prolonged stay in the hospital. The laboratory testing also needs to be repeated.”

Proper training on blood culture collection is critical to patient safety. To address these concerns, ASCP has developed a new training module, Blood Culture Collection Best Practices for Laboratory Professionals, developed for phlebotomists and laboratory professionals to share best practices on how to collect adult blood cultures and reduce risk of contamination which can cause delays in diagnosis and treatment and patient safety concerns. The training was developed from the best practices on blood culture collection established by the Clinical & Laboratory Standards Institute (CLSI) and the Infectious Disease Society of America (IDSA).

This training is a freely available resource available through the ASCP store. There is no cost to use the training. It was developed by Dr. Gupta through ASCP’s support of the CDC OneLab^TM Initiative through a cooperative agreement from the Centers for Disease Control and Prevention (CDC). The CDC also has developed complementary training tools and job aids which can be downloaded from its website.

According to the CDC online tool, laboratories are required by the Clinical Laboratory Improvement Act (CLIA) of 1988 to “monitor, assess, and when indicated, correct problems identified in their preanalytic systems. Using the methods provided in this quality tool to calculate the blood culture contamination rates will help meet this standard and ensure optimal blood culture collection.”¹

The ASCP training module specifies that a blood culture set from an adult patient “should consist of 20–30 mL of blood collected through venipuncture. This may require more than two bottles, depending on the blood culture system and the institutional policy.”¹ 

Each step of blood collection is critical, notes Dr. Gupta. For instance, “you need to make sure the venipuncture site is disinfected from where the blood will be collected, the blood culture bottles need to be filled accurately, then you need to label each of the two bottles correctly,” he explains. 

All of these steps may seem self-evident. However, Dr. Gupta recalls seeing numerous errors in blood collection occur during a previous job at a community hospital in Florida.

“There were variations among practices in how they collected blood cultures,” he says. “This involved other healthcare workers such as a nurse or patient care technologist, not just phlebotomists. The key is to know about and use best practices during the process of blood collection.” 

Dr. Gupta explains that his previous workplace practices continuous improvement to reduce the blood culture contamination rate. He and his colleagues throughout the hospital worked in multidisciplinary teams to discuss the process of blood culture collection. The health system leadership realized that some of the other professionals who were collecting blood had not been properly trained. He brought that knowledge with him when he joined the ASCP staff a few years ago and was only too happy to address blood culture training when the opportunity arose.

That is how this new ASCP training module came to be a part of ASCP’s contribution toward the CDC OneLab Initiative. “The [CDC OneLab] Initiative, overall, is intended to unify the laboratory workforce and provide a centralized location for laboratory training materials,” says Debby Basu, PhD, Senior Manager of the ASCP Center for Global Health. “One part of creating useful and enduring laboratory training materials is performing a needs assessment to identify laboratory training needs. We conducted a needs assessment last year which showed that laboratory professionals are very interested in educational materials on this topic. The training is also very timely because, as we all know, there is a current shortage of blood culture bottles,” she said.  

“Clinical laboratories are in a period of crisis because one of the main manufacturers of blood culture bottles is unable to meet global demand because of an issue with one of their suppliers,” Dr. Basu explains. “For that reason, it is even more important that our practices for blood culture collection are precise so that we don’t have to recollect more blood and waste limited quantities of blood culture bottles.”

“We want to emphasize that while the best practices in this training are considered the current gold standard, a lot of our laboratories are now put in the situation where they must adapt and modify blood culture utilization practices due to these existing supply shortages. It will be interesting to see if blood culture utilization schemes and practices may change long-term across institutions because of the blood culture bottle shortage,” Dr. Basu says.

Resources

1.   CDC Blood Culture Contamination Prevention. https://www.cdc.gov/labquality/blood-culture-contamination-prevention.html#anchor_78407. Accessed 8/29/2024.

Susan Montgomery, MBA, is a communications writer for ASCP.