Blood Culture Contaminations: Every[one] Makes a Difference

Introduction: Blood culture contamination rates at Cheyenne Regional Medical Center were noted above the 3% national average, at 3.8% in 2020 and 4.1% in 2021. According to the CDC, blood culture contaminations are associated with an increased length of stay, inappropriate use of antibiotics, & create a financial burden for the patient and hospital ($4,538 per contamination). By introducing CDC blood culture collection guidelines, the goal was to achieve & maintain >1% contamination rate.


Methods: We implemented multiple PDSA cycles while introducing 1 CDC best practice at a time. Contaminations are tracked monthly by staff member and unit they occur in. Once a new best practice change was implemented and in its "maintenance phase", meaning no spike in contamination, we would implement another best practice.


Results: Since the project introduction in 2022, we have successfully decreased blood culture contaminations at CRMC to align with CDC recommendations of < 1% so far in 2025.
Utilizing a diversion device was identified as the first best practice to implement in the organization, with a usage goal of 80%. Our contamination rate dropped from 4.1% in 2021 to 2.4% in 2022. For further reduction goals in 2023, the team trained ED Paramedics and vascular access nurses on appropriate use of the device, worked with the lab to implement new best practices such as no cultures drawn via syringe, no cultures collected in high-risk situations (trauma, code, stroke, etc), and no cultures handed to lab personnel unlabeled. These small but meaningful changes resulted in a 2023 contamination rate of 1.8%.
After maintaining < 3% contamination rate for 23 months, a 1.5% goal (half the previous) was approved by the sepsis program & lab leadership. With ER staff collecting 1 set of cultures, and the phlebotomists collecting the 2nd, we successfully ended 2024 at a rate of 1.29%! For 2025, we show a 0.94% contamination rate after providing clinical staff reinforcement training on blood culture collections and utilizing the vascular access nurses only for central line collections (if indicated).


Conclusions: Implementing CDC best practices for blood cultures collections one at a time, utilizing multiple PDSA cycles with each change, has proven successful decline in contamination rates; from 4.1% to < 1% over a 4 year period.