Interventions to reduce peripheral blood culture contamination in acute care settings: A systematic review and meta-analysis

BackgroundBlood culture contamination is a significant problem in acute care settings. Contamination of a blood sample with pathogens not present in the patients blood leads to increases in length of stay, overuse of antimicrobials, and increases in healthcare cost. Several interventions have been reported in different settings within the literature to decrease the contamination. However, their overall effectiveness is currently unknown. ObjectiveThis systematic review aimed to identify interventions to reduce contamination from peripherally collected blood cultures and to evaluate the effectiveness of these interventions. DesignSystematic review and meta-analysis MethodsIn March 2019 we performed a systematic search of English language literature from academic databases, registers of clinical trials and grey literature for interventions aimed at reducing blood culture contamination in adult acute care settings. Studies meeting inclusion criteria were reviewed and data were extracted by two independent reviewers. ResultsA total of 6,302 articles were retrieved from searches. After removal of duplicates and screening against inclusion criteria 57 studies were included. The majority of the 57 studies had a medium to high risk of bias. These studies identified eight specific interventions (collection packs, dedicated collection teams, education, staff feedback, intervention bundle, sterile procedure, Initial Specimen Diversion Devices, or change of asepsis solution) used in acute care. Thirty-four studies were included in the meta-analysis. There was a wide variation in the definition of contamination which precluded many studies from being included in the meta-analysis. Dedicated collection teams (RR 0.40, 95%CI 0.21 - 0.76, I2 87%, p<0.001) and initial specimen diversion devices (RR 0.43, 95%CI0.31 - 0.58, I2 84%, p<0.001) were the most successful at reducing blood culture contamination. Heterogeneity was high across all studies and interventions. ConclusionsThe use of dedicated collection teams or initial specimen diversion devices showed the most significant reduction in blood culture contamination; however, other interventions such as intervention bundles, education or feedback, may have benefits in terms of ease of implementation, and have still been shown to lower blood culture contamination.