Diversion Principle Reduces Skin Flora Contamination Rates in a Community Hospital.

Context.—: Blood culture contamination is a common problem faced by medical centers and leads to significant cost. A possible method to reduce contamination is to discard the initial aliquot of blood, which contains skin and bacteria.

Objective.—: To determine whether the rate of contaminant blood cultures could be reduced by changing the order of draw to divert the first 7 mL to a gold- or green-top tube.

Design.—: A preintervention and postintervention study was conducted. During the 18-month intervention phase (September 2015-February 2017), all nurses in the emergency department and inpatient floor phlebotomists collected blood cultures by drawing the first 7 mL of blood into a gold- or green-top tube followed by drawing blood for blood culture bottles. The 18 months immediately preceding the study period (February 2014-July 2015) were used for comparison.

Results.—: There was an overall statistically significant decrease in contamination rate from 2.46% in the prediversion protocol group to 1.70% in the postdiversion protocol group ( < .001). Emergency department drawn cultures and inpatient cultures showed significant decrease in contamination rates between the preprotocol and postprotocol groups, 2.92% versus 1.95% ( < .001) for emergency department, and 1.82% versus 1.31% ( = .03) for inpatient. We noted less month-to-month variation during the study period compared with the preintervention period.

Conclusions.—: By using this simple diversion method, we were able to improve blood culture contamination rates for our emergency department and inpatients while incurring no added cost to the procedure.