Vol.68 No.5 September 2020
Evaluation of the effectiveness of chlorhexidine alcohol for reducing blood culture contamination rate
1)Department of Pharmacy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, Japan
2)Department of Nursing, Hiroshima City Hiroshima Citizens Hospital
3)Department of Emergency, Hiroshima City Hiroshima Citizens Hospital
4)Department of General Internal Medicine, Hiroshima City Hiroshima Citizens Hospital
Abstract
Blood cultures are important for the diagnosis of infectious diseases. In Hiroshima City Hiroshima Citizens Hospital, we revised our blood culture sampling method in April 2019 to reduce blood culture contamination rate. The antiseptic used for blood culture work was changed from 10% povidone-iodine (PVP-I) to 1% chlorhexidine-alcohol (CHG-AL). We investigated the blood culture contamination rate from April 2018 to March 2020 at our hospital. The period from April 2018 to March 2019 was defined as prerevision months and April 2019 to March 2020 as post revision. The contamination rates of these two periods were compared. A blood culture was considered contaminated if one of the following organisms were identified in only one in a series of blood culture specimens: coagulase-negative staphylococci (CNS), Propionibacterium acnes, Micrococcus species, Viridans-group streptococci, Corynebacterium species, Bacillus species, and Clostridium species. In addition, we distributed a questionnaire among nurses who collect blood and examined the changes in their responses before and after the revision in the method. The total number of blood cultures was 3,681 before revision and 3,971 after revision. The blood culture contamination rate significantly decreased from 3.45% before revision to 1.71% after revision. Furthermore, the blood culture contamination rate significantly decreased for CNS and Bacillus species and did not change for other bacteria. We analyzed the questionnaire with 187 valid responses. The questionnaire results indicate that 79.7% of respondents knew need for time to dry after applying PVP-I, whereas, 70.6% of respondents indicated that they may not have been able to comply with the drying time after applying PVP-I. In addition, 57.8% answered that CHG-AL is suitable as an antiseptic for use in blood culture work. Therefore, we were able to reduce the blood culture contamination rate by changing the antiseptic used for blood culture work from 10% PVP-I to 1% CHG-AL. In addition, this change did not increase the burden on the medical staff that collects blood samples.
Key word
blood culture, contamination, coagulase-negative staphylococci, Clostridium, chlorhexidine alcohol
Received
May 13, 2020
Accepted
July 10, 2020
Jpn. J. Chemother. 68 (5): 584-589, 2020
