Reducing Blood Culture Contamination

To reduce contaminated blood cultures, collectors should be mindful of these sound blood culture collection practices:

1. Cleanse the intended puncture site thoroughly with a 30-60 second scrub with an appropriate antiseptic. Cutting down the time in this step invites contamination.
2. Allow the antiseptic time to dry. Complete asepsis is only accomplished when iodine compounds are in a dried state.
3. Do not touch a site after cleansing. The temptation is great, especially for hard-to-find veins, but rely on skin markers (freckles, hair, creases in the skin, etc.) to remind you where the vein is after cleansing.
4. Cleanse the tops of culture vials. Unless it is against the manufacturer's recommendation, wipe the tops of the vials with iodine, allow to dry, and remove with 70% isopropyl alcohol to assure the needle doesn't carry bacteria from the stopper into the broth.

Follow the Order of Draw. When collecting blood for other tests, fill the culture vials first. To reverse the order is to contaminate the blood culture.

Specimen Collection Safety: butterfly sets

When you use winged infusion (butterfly) sets to draw blood, do you immediately activate the safety feature? Before safety features became prevalent on winged blood collection sets, these devices were shown to be responsible for 32 percent of all accidental needlesticks to phlebotomists. But if you are one of the many who worship these handy blood collection sets, make sure the device you use has a safety feature that you routinely and immediately activate. Although recent advances have made them safer, too many healthcare workers aren't activating the safety feature.

There are times when butterfly sets are appropriate; limit their use to those occasions. Whenever using them, make sure you respect them, and activate the safety feature immediately and according to manufacturer's instructions.

Phlebotomy Answers 24/7/365

Phlebotomy Central is the single most comprehensive source of specimen collection information on the Internet. The goal of the members-only section of the Center for Phlebotomy Education's web site is to provide the global phlebotomy community with accurate information that is accessible 24/7/365. Launched in January, Phlebotomy Central is the most comprehensive compilation of specimen collection information ever available on the Internet. Phlebotomy Central has three sections: To The Point ™ articles, FAQs, and all issues of Phlebotomy Today , current and archived.

The FAQ section features answers to the most common questions posed to the Center on all aspects of specimen collection and management since its founding in 1998. The Articles section contains 15 lengthy To The Point™ articles on a wide variety of specimen collection topics, previously available only on a pay-per-download basis. All articles are free to Phlebotomy Central members. The Newsletter section includes an institutional subscription to Phlebotomy Today as well as access to seven years of back issues, previously unavailable. For more information, visit www.phlebotomy.com/PhlebotomyCentral.html.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter, are reading about this month:

• Feature Article: Phlebotomy Training in South Africa
• Ask the Safety Lady: OSHA consultant addresses these burning questions:
  •  Where should sharps containers be located?
  • The chairs we have in the phlebotomy drawing area keep sliding out from underneath me when I try to sit down. What can be done to prevent this?
  • How often should my phlebotomy tray be cleaned?
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in February including these stories:
  • Displaced Nurse Opens Own Phlebotomy Service
  • UK Labs Bracing for Outpatient Chaos
  • Phlebotomist Blows Whistle on Employer
  • UK Phlebotomists Push For National Qualifications
  • Phlebotomy Student Found Dead; Family Protests Investigation
  • Device that Maps Veins for Phlebotomy Profiled
  • “What does a Phlebotomist Do?” Stumps Academic Team
  • Hospital Opens Draw Station at Grocery Store
• According to the Standards: Wiping off Alcohol?
• Tip of the Month: Standard Eyes
• On a Personal Note: Last night I think I got a glimpse of what it’s like to go to heaven.

For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current month’s issue will be emailed to you immediately upon subscribing.

Phlebotomy Today Archives

Ever since the first issue of Phlebotomy Today was published online in February 2000, thousands of healthcare professionals around the world have been clamoring for archives. This month, the Center for Phlebotomy Education releases them on CD.

Seven years of back issues will be included on the disk, 81 issues in all, for $49.95. The CD will be searchable by keyword or by individual issue, simplifying the location of articles on specific topics. Avid readers will be pleased to know the CD includes all of the editor's "On a Personal Note" essays.

The archives are in printer-friendly PDF format and requires Adobe Acrobat 7.0 to view and print. A link to Acrobat is provided on the CD. Although each issue includes the "Tip of the Month", the printer-friendly version is not included. (The Center is compiling 70+ tips, attractively designed and printed for selective posting and shipped with a durable acrylic frame. The Tip of the Month collection will be offered in early 2007.)

For more information on the archives CD, visit www.phlebotomy.com/Products.html.

Featured FAQ:
Blood Culture Collections

Each month, PT-STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's web site. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.

Question:
What's most important for blood culture collection: the number of sites or the volume drawn? Is there a difference if you drawn 40 cc from one site or 20 cc from two different sites on an adult?

Response:
The following is a passage from my text titled Applied Phlebotomy: “If multiple sets are ordered, they may be collected at the same time in two consecutive venipunctures in different sites or from the same site at intervals of 30-45 minutes. Multiple sets are never drawn and inoculated with the blood drawn from one venipuncture. There are two reasons for performing a separate venipuncture for each set. One reason is that if the site was not properly disinfected or if the collector failed to exercise aseptic technique, all bottles filled from the same draw are likely to be falsely positive. When drawn separately, poor technique is less likely to result in the contamination of both sets. The second reason is to sample two entirely different bloodstreams in order to increase the chance of capturing organisms that exist in low concentrations. Therefore the patient is best served when multiple sets are collected from separate venipunctures performed at the same time from different sites or from the same site 30-45 minutes apart.”

I might add that the American Society of Microbiology defines one set of blood cultures as that blood obtained from one venipuncture.

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