HAEMATOLOGY


Hospital management Overcrowding in hospitals is a common and extremely difficult problem to rectify in many well-developed countries. With average global life expectancy increasing, greater numbers of patients present with one or more comorbidity. This results in more complicated health complaints and social care issues thus increasing the LOS in hospitals and episodes of ‘bed blocking’.17 The consequence of ‘bed-blocking’ is extended waiting times for elective patients, patients being left on trolleys in emergency departments and delays in treatments for other inpatients.


These complications often result in a chain of administrative problems for bed management and hospital administrative teams such as procedure rescheduling, re-staffing and repeatedly moving patients to different areas in a hospital.17


blood culture contamination rates is one potential way to regain hospital bed days that are occupied by false positives.6,12


contamination, could therefore result in significant unnecessary costs to hospitals (see Table 1).


The macro financial burden of false positive blood cultures to the UK & Irish healthcare systems is potentially enormous. Taking 175,000 false positives (UK), at an average contamination rate of 5%, creates financial wastage of approximately £875M annually. New technology offers an opportunity to significantly reduce this financial burden.


How can we reduce blood culture contamination?


Blood culture contamination is a complex and challenging problem,3


but there are now Reducing One


study calculated that 254 false positive blood cultures had cost Antrim Area Hospital (NI) 1372 extra bed days.12


Regaining these


days is a simple efficiency measure that will lighten the burden of ‘bed blocking’ for hospitals.


Financial Implication


Blood culture contamination has a large financial impact on hospitals and patients. Contamination creates a burden on resources within hospitals and the significance of these financial implications may not be immediately clear as they will be distributed across many parts of the organisation. Increased costs are due to LOS, greater antibiotic use, increased diagnostic testing and subsequent laboratory time.18 Indeed, compared with true negative results, false positive results were independently associated with a 20% increase in laboratory charges and a 39% increase in intravenous antibiotic charges.11 High rates of contaminants are a clear fiscal burden to the laboratory as they necessitate the retesting of samples, or obtaining new samples, which is time consuming and a drain on staff resources. Increased LOS is often discussed as one of the main financial burdens for hospitals. As with actual cost per contamination, increased LOS due to a blood culture contamination can differ in studies. However, it is reliably quoted as being between 2-8 days.5,6,11,12


This increase in LOS has


important financial implications given that beds come at a daily cost to hospitals. The NHS quoted a non-elective ‘bed day’ as costing £1,60320


and similarly, Dublin


based Irish hospitals quote the ‘full economic cost of an average bed day’ as €1,223- 1,597.20


NOVEMBER 2020 Increased LOS, due to blood culture


multiple interventions that can be utilised to aid in the significant reduction of BCC. Clear procedural protocols with education and regular staff training,21


accompanied with


the use of procedure kits including evidence based technology3


have all helped to get


BCC rates to the current levels of between 4% and 5%, which is still notably above the universally ‘acceptable’ BCC of 3%.1 New technology in the form of a specimen diversion device, Kurin, has recently been made available in the UK & Ireland. The blood culture collection system has been proven to significantly reduce BCC. When collecting a sample for blood culture, the device automatically diverts the initial 0.15ml of blood into an alternative locking chamber.


This directs the potential source of contamination away from the blood collection bottles, thus allowing for more accurate blood culture results. The product is a passive intervention, which does not require a change in clinicians’ chosen practice of venepuncture.22


About the authors


incredibly high returns for hospitals by implementing mixed strategies including blood culture procedure kits utilising new evidence-based technology, such as Kurin, and implementation of protocol education. For a blood culture test to be revered as the ‘gold standard’ it needs to be upheld as having the lowest possible error rate and negative effects on patients and hospitals. With some simple interventions we can now have in sight a possible zero blood culture contamination standard and thus improve patient outcomes.


References available on request


CSJ


Kurin has been


shown to reduce contamination rates by up to 90%, even in hospitals with BCC rates lower than the accepted 3%.23,24


Data from


hospitals who use this product estimate savings ranging from $260,000 -$1.3M, depending on initial rate of BCC and number of blood cultures taken.22


Summary


Contaminated blood cultures create a significant clinical and financial burden on the healthcare system, and it is imperative that hospital management and clinicians are made aware of and recognise these ongoing issues. Contamination of blood cultures and false positives create significant financial burdens to every department involved in the processing of blood cultures. Patients experience negative outcomes in the form of unnecessary antibiotic treatment, further testing and extended hospital stays, which in a COVID-19 environment comes with an elevated risk. Relatively low upfront costs can yield


Étáin O’Keefe RGN, is an ICU nurse and clinical specialist in IV Access at Iskus Health. Having spent 6 years nursing in surgical wards and ICUs in the UK & Jersey Channel Islands her focus has shifted to clinical education around evidence-based technologies in the area of vascular access. She has a special interest in blood cultures and improving contamination rates.


Stuart Murray is the commercial director at Iskus Health. Having spent over 20 years commercialising medical devices, he has a passion for clinically evidenced based technology which improves patient outcomes. Delivering significant and sustainable reductions in blood culture contamination through simple innovative solutions has been a key mission at Iskus Health for over 15 years.


WWW.CLINICALSERVICESJOURNAL.COM l 45


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100