Which Cleaning Agents Are Used To Clean A Site For Blood Culture
J Clin Microbiol. 2002 May; 40(5): 1660–1665.
Comparing of Four Antiseptic Preparations for Skin in the Prevention of Contamination of Percutaneously Drawn Blood Cultures: a Randomized Trial
David P. Calfee
Department of Medicine, Academy of Virginia Wellness System, Charlottesville, Virginia 22908
Barry M. Farr
Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908
Received 2001 Nov xxx; Revised 2002 January 17; Accepted 2002 Feb 12.
Abstract
A number of skin antiseptics have been used to prevent the contamination of blood cultures, but the comparative efficacies of these agents have not been extensively evaluated. Nosotros therefore sought to compare the efficacy of four pare antiseptics in preventing blood civilisation contagion in a randomized, crossover, investigator-blinded study conducted in an emergency department and the inpatient wards of a university hospital. The patient group included all patients from whom blood samples were obtained percutaneously for culture. Peel antisepsis was performed with x% povidone-iodine, 70% isopropyl alcohol, tincture of iodine, or povidone-iodine with 70% ethyl alcohol (i.e., Persist). The blood culture contamination rate associated with each antiseptic was so determined. A total of 333 (2.62%) of 12,692 blood cultures were contaminated during the study flow compared to 413 (3.21%) of 12,859 blood cultures obtained during the previous 12-month period (relative risk = 0.82; 95% confidence interval, 0.71 to 0.94; P = 0.006). During the study, the contamination rates were adamant to be two.93% with povidone-iodine, two.58% with tincture of iodine, 2.l% with isopropyl alcohol, and 2.46% with Persist (P = 0.62). We detected no significant differences in the blood culture contamination rates among these four antiseptics, although there was some bear witness suggesting greater efficacy amid the alcohol-containing antiseptics. Among the evaluated antiseptics, isopropyl alcohol may be the optimal antiseptic for use prior to obtaining blood for culture, given its convenience, depression price, and tolerability.
Claret cultures are of import for the diagnosis and management of bloodstream infections. Because of the low threshold that many clinicians maintain for obtaining blood cultures, the number of cultures obtained far exceeds the number of bloodstream infections diagnosed. As with any screening or diagnostic test performed in a population with a low prevalence of disease, many claret cultures are found to be falsely positive. False positives result from the introduction of organisms from a site outside of the bloodstream into the sample of blood obtained for culture. This is referred to as contamination of the culture.
The problem of claret culture contagion is widespread. Up to l% of all positive cultures may exist positive due to the presence of contaminants (two, eight, 22). Recent studies have reported that 0.6 to 6.25% of percutaneously fatigued cultures are contaminated (6, 10, 15, 19, 20). Coagulase-negative staphylococci and other pare flora are the most mutual contaminants. Unfortunately, these organisms tin also exist meaning pathogens. I study institute that 25 to 37% of cultures yielding coagulase-negative staphylococci represented significant bacteremia (19). Thus, difficult diagnostic and therapeutic dilemmas arise when these organisms are isolated. For example, although physicians were found to exist quite authentic in determining the significance of cultures growing coagulase-negative staphylococci, almost one-half of the patients with simulated-positive cultures still received antibiotics (19).
The consequences arising from contaminated cultures are not trivial. In a prospective observational report, Bates and colleagues examined the costs and length of stay for hospitalized adults from whom claret cultures were obtained (three). Based on multivariable analyses, charges for patients with contaminated cultures were constitute to exist significantly higher for intravenous antibiotics (median, $874 versus $492), total laboratory costs (median, $ii,056 versus $one,426), and microbiology costs (median, $460 versus $219) than for patients with negative cultures. The total excess price associated with contamination was $iv,385 per patient. There was also a trend toward longer hospitalization (median, 12.5 versus viii days). In another study, the mean total costs were $4,100 higher for patients with contaminated cultures compared to those with negative cultures (7). In addition to financial excesses, one must also consider issues such every bit the development of antimicrobial resistance due to unnecessary antibiotic exposure and the individual patient's physical and psychological reactions to additional testing and prolonged hospitalization.
Antisepsis of the skin at the venipuncture site is used to prevent contamination by decreasing the bacterial counts of the resident flora. This practice cannot completely prevent contamination, nonetheless, because ca. 20% of skin bacteria are located in deep layers of the skin or in other structures into which antiseptics cannot penetrate (17). A number of antiseptics have been used for this purpose, including booze, povidone-iodine, tincture of iodine, and chlorhexidine. Povidone-iodine is probably virtually commonly used, although three studies take institute tincture of iodine to be more than constructive (7, 16, 20). The present study was designed to compare four commercially available skin antiseptics: povidone-iodine, tincture of iodine, isopropyl alcohol, and povidone-iodine with alcohol (Persist).
(This study was presented in role at the 11th Annual Scientific Meeting of the Club for Healthcare Epidemiology of America, Toronto, Canada, 1 to 3 April 2001 [abstr. 268].)
MATERIALS AND METHODS
Written report design.
A randomized, crossover, investigator-blinded design was selected. This was selected to maximize the number of cultures included and to permit both concurrent controls for each group and historical comparisons inside each group. Blood cultures drawn percutaneously in the emergency department and on all inpatient intendance units, except the neonatal intensive care unit, were included. Informed consent was considered unnecessary by the Homo Investigation Commission of the Academy of Virginia Wellness System. Patients were divided into four intervention groups based on the hospital unit on which they were located. Groups were determined based on the geographic location and subspecialty of the hospital units. Units located close to one some other and units that shared staff were included in the same grouping. This method of group consignment was selected in order to decrease the incidence of the use of an antiseptic other than the i randomized to each group due to whatever sharing of supplies beyond related units. At the beginning of the study, one of the four antiseptics was assigned to each study group for use with all cultures drawn over the following 12-week period. Packages of the assigned antiseptic were located next to the blood culture vials in the supply room of each unit. Povidone-iodine-saturated pads were relocated to a more than distant site to discourage their employ for claret cultures and to promote use of the assigned antiseptic. At the end of this period, the antiseptics were rotated amongst the written report groups and a 2d 12-week study period followed a 2-calendar week washout period.
At the cease of each study flow, the antiseptic was removed from each unit and replaced with the antiseptic to be used during the post-obit catamenia. A ii-week washout menstruum during which no data were collected separated each study flow so that any antiseptic remaining from the previous study period could be used or removed from the unit prior to first evaluation of a dissimilar antiseptic. This rotation occurred iii times and then that all study groups could utilize all four antiseptics.
Materials.
Tincture of iodine (ii% iodine and 2% potassium iodide in 47% ethyl alcohol [TI]), seventy% isopropyl alcohol (IPA), ten% povidone-iodine (PI), and Persist (povidone-iodine and lxx% ethyl alcohol) were packaged in identical envelopes distinguishable but by a characterization with the letter of the alphabet A, B, C, or D, which was assigned to each clarified by the sponsor. Each packet contained 3 swabs. Persist was produced by Becton Dickinson, in Sandy, Utah. The IPA, PI, and TI were obtained from Aplicare (Branford, Conn.). Aplicare packaged all iv products.
Phlebotomy technique.
Before the beginning study period, an educational programme regarding the phlebotomy technique was presented to all healthcare workers responsible for obtaining blood culture specimens. A pocket-sized copy of a detailed clarification of the preferred technique was distributed during the oral presentation and was also mailed to resident physicians with their paychecks (Table 1).
Table 1.
Recommended phlebotomy protocol
| Step | Claret civilisation report protocol a |
|---|---|
| i | Obtain i envelope from the "antiseptic pare prep for blood culture" box. Each of these packages will comprise three swabsticks soaked in an clarified agent. Blood civilization bottles, tourniquet, syringe(s), butterfly needles, alcohol pads, gauze pads, and cast(due south) should also be obtained. |
| 2 | Select the site of venipuncture. (If the patient is unusually dirty, wash the intended site with soap and water prior to venipuncture.) |
| 3 | Put on exam gloves. |
| four | Open up the bundle and remove one swabstick. |
| 5 | Scrub the venipuncture site gently simply firmly with the swabstick kickoff in the center and standing in an outward direction using round strokes for an surface area 2 to 3 in. in diameter. |
| vi | Repeat this procedure for the two remaining swabsticks. |
| 7 | Later on the third swab, allow the area to dry completely. (Fifty-fifty if the surface area appears to be dry sooner, wait at least ane full minute earlier venipuncture is performed.) |
| 8 | Prepare the culture bottles for inoculation and wipe the tops with a sterile alcohol pad. |
| 9 | Apply a tourniquet, being careful non to impact the prepped area with gloves or tourniquet. |
| x | Perform phlebotomy past using the needle and syringe. (A 20-ml portion of blood per set of cultures is recommended for adult patients.) |
| xi | Directly inoculate the blood culture bottles past using the same needle used to perform the phlebotomy (i.eastward., practice not alter needles). Note: if a blood sample is drawn at the time of placement of a new intravascular catheter or at the initiation of hemodialysis through a graft or fistula, fix the peel every bit described above and describe the sample through the catheter into a syringe. Using aseptic technique, identify a sterile needle on the syringe and inoculate the culture bottles. |
| 12 | Dispose of the needle and syringe in the appropriate sharps container. |
| 13 | Send the blood samples to the lab by the standard protocol. No special handling or labeling is required for this study. |
| 14 | Use an alcohol pad (or pads) to wipe the prepped area until none of the color from the skin prep remains (i.e., the white booze pad should remain white subsequently rubbing). (Note: not all of the skin preparations will discolor the peel, merely wipe the surface area with an alcohol pad anyway.) |
Equipment was assembled prior to beginning the procedure. Exam gloves were worn during the procedure. The site was scrubbed firmly simply gently with a swab beginning directly over the site of venipuncture and standing in an outward management by using circular strokes. This was repeated with the remaining two swabs. The surface area was allowed to dry completely subsequently the third swab with a minimum filibuster of 1 min. While the site was drying, civilization bottles were prepared. The tops were wiped with an alcohol pad that was then placed over the septum until the time of inoculation. A tourniquet was applied proximal to the venipuncture site, and the blood sample was obtained with a butterfly needle and syringe, with care taken not to bear upon the prepped area. Culture bottles were inoculated by using the same needle used to perform the phlebotomy. The tourniquet was removed, and the venipuncture site was wiped with alcohol-saturated pads until any and all traces of colour from the antiseptic had been removed.
Standard aerobic and anaerobic bottles were processed by the microbiology laboratory according to standard protocols past using BacT Alert, a continuously monitored, carbon dioxide detection system (Organon Teknika Corporation, Durham, N.C.). Specimens were incubated for 7 days unless the ordering physician requested a longer incubation. All positive vials were inoculated onto appropriate media and further candy by conventional techniques.
Data collection.
The number of percutaneously drawn cultures performed in each unit was obtained weekly from the laboratory's computerized database. Each culture was classified as either negative (i.e., no growth) or positive. A blinded dr. investigator (D. P. Calfee), who had no blood drove responsibilities, reviewed the positive cultures and farther classified them, based on a previously described method, every bit true positive or every bit contaminated (10, fifteen). A culture was classified equally contaminated if a common pare organism (i.eastward., coagulase-negative staphylococci, Micrococcus species, Propionibacterium acnes, viridans streptococci, Corynebacterium species other than group JK, or Bacillus species) was isolated from only one of two or more blood samples obtained from different sites. Published national guidelines accept considered such cultures to exist false positive and have recommended against antimicrobial therapy (1, nine). Cultures yielding such an organism for which in that location was no companion civilisation for comparing were excluded from the analysis. The contagion rate was calculated by dividing the number of cultures classified as contaminated by the full number of cultures included in the assay. This was done for each patient care unit of measurement during each study menstruum. After the randomization code was broken after completion of the report, the overall contamination rate and private contamination rates for each antiseptic were calculated. This method was likewise used by the aforementioned blinded investigator to calculate the baseline charge per unit of contagion during a 12-month menses prior to initiation of the study protocol, during which time PI was used for skin antisepsis. Blood samples for culture were obtained by a similar range of personnel (physicians, nurses, and phlebotomists) during the study and baseline periods.
Each week, the blinded physician investigator visited all of the study units. The number of remaining antiseptic packages was counted, and boosted packages were provided to replace those used during the previous week. Compliance with the study (i.due east., use of the assigned antiseptic) was estimated on a weekly basis by comparison the number of cultures fatigued on each unit to the number of antiseptic packages used on that unit. Personnel working on units with low weekly compliance rates were reminded of the protocol. Study personnel did non straight find phlebotomy procedures.
Statistical assay.
A sample size of i,775 per study arm was calculated to exist necessary to achieve 80% power in detecting a 2% deviation in contagion rates (assuming contamination rates of 4% with i antiseptic and 2% with some other). This adding was based on a Bonferroni multiple comparison procedure to allow comparison of each report arm to all other study arms, if such comparisons were indicated past the detection of a significant difference among the four antiseptics. In that instance, plans were fabricated to divide the usual blastoff of 0.05 by the number of potential intergroup comparisons (i.e., vi) to produce a new alpha level of 0.008 for each intergroup comparing. Contamination rates were compared by using the chi-foursquare test.
Cost analysis.
The total cost associated with the use of each antiseptic was calculated. This judge included the annual cost of the antiseptic (as calculated by multiplying the price of antiseptic for ane blood civilization by the number of claret cultures performed during the 12-month study catamenia) and the excess toll attributable to blood civilisation contamination. The price of each antiseptic for one blood culture was obtained from the Materiel Support Services of the University of Virginia Health Organization. The backlog cost of contamination was calculated by multiplying the estimated number of contaminated cultures occurring over a period of ane year (using the contagion rates observed during the report) by the excess price attributed to a contaminated blood civilization at ane institution ($iv,100) (7). This was seen every bit an appropriate approximate due to the adding of a similar excess cost in a divide study at a different institution (iii). The calculated total costs were compared to make up one's mind the savings or excesses associated with the use of each antiseptic.
RESULTS
The period of 1 October 1998 through 30 September 1999 served as the baseline period. During this interval, 413 (3.21%) of 12,859 percutaneously drawn cultures were contaminated. During the written report, 12,806 blood cultures were obtained percutaneously. A total of 12,692 (99.1%) of these cultures met the criteria for inclusion in the analysis; 333 (2.62%) were found to be contaminated. This represented a significant reduction in contamination (relative risk [RR] = 0.82, 95% confidence interval [CI] = 0.71 to 0.94, P = 0.006). Individual contamination rates for the four antiseptics were 2.93% (99 of 3,378) for PI, 2.58% (81 of 3,138) for TI, 2.50% (78 of 3,125) for IPA, and 2.46% (75 of 3,051) for Persist (P = 0.62). The relative risks of contamination with PI, TI, Persist, and IPA during the study were 0.91 (95% CI = 0.74 to 1.14, P = 0.44), 0.80 (95% CI = 0.62 to 1.02, P = 0.067), 0.77 (95% CI = 0.59 to 0.98, P = 0.03), and 0.78 (95% CI = 0.6 to 0.99, P = 0.038), respectively, compared with the apply of PI during the baseline period.
The results of the written report did not announced to have been influenced past any one particular study group. While at that place was variability in the contamination charge per unit associated with each antiseptic among the four groups, the relative efficacies of the antiseptics within each group were similar (Table 2). There were no statistically pregnant intragroup differences among contamination rates between whatsoever of the four antiseptics. PI had the highest rate of contamination in all four groups. Group 1, the emergency department, consistently demonstrated the highest contamination rates. Full general medical and oncology wards and the medical intensive care unit (grouping 2) and the cardiac, pediatric, and obstetrics-gynecology wards and cardiac and pediatric intensive care units (group three) had the lowest contamination rates. Surgical wards and surgical intensive care units (group 4) had intermediate contamination rates. The overall risk of blood civilization contamination was greater in group ane than in groups 2 (odds ratio [OR] = 1.48, 95% CI = one.09 to 2.01, P < 0.01) and 3 (OR = 1.81, 95% CI = i.26 to ii.61, P < 0.001). The take chances of contagion was also greater in grouping 4 than in groups 2 (OR = 1.three, 95% CI = 0.96 to one.77, P = 0.08) and three (OR = i.60, 95% CI = 1.11 to 2.30, P < 0.01). There was no apparent association between blood civilization contagion and season or the order in which the antiseptics were used, equally evidenced by the lack of pregnant differences in contamination within groups during the four study periods, whose dates roughly approximated those of the four seasons (Fig. 1).
Contamination rates for each clarified during each of the iv written report periods. The characterization in a higher place each bar indicates the study grouping with the clarified during each menstruum (e.m., "G1" indicates group one).
Tabular array two.
Claret culture contamination rates among individual study groups
| Grouping a | Contamination rate (%) b | ||||
|---|---|---|---|---|---|
| TI | PI | IPA | Persist | Overall | |
| 1 | three.32 | 3.47 | 3.23 | three.thirteen | iii.30 |
| 2 | one.76 | 2.69 | 2.32 | 2.21 | ii.26∗ |
| iii | 2.02 | 2.07 | 1.56 | 1.79 | one.85∗† |
| four | 2.89 | 3.29 | two.87 | ii.67 | two.92 |
| Overall | 2.58 | two.93 | 2.50 | two.46 | 2.62 |
Overall, coagulase-negative staphylococci accounted for 76.viii% of all blood culture isolates classified equally contaminants. Other contaminating organisms included Propionibacterium species (7%), viridans streptococci (4.7%), Bacillus species (iv.7%), Corynebacterium species (3.8%), and Micrococcus species (ii.9%). The frequency distribution of contaminating organisms was similar among the 4 antiseptics (data not shown).
Overall, compliance was good. Estimated compliance exceeded 100% on twenty units, indicating the use of more than than one packet per culture drawn. This was likely due to failed venipuncture attempts, necessitating skin prepping at multiple sites. Three units had overall compliance rates of 93 to 97%. The vi remaining units had overall compliance rates ranging from 15% to sixty%. These 6 units performed 220 (1.7%) of the cultures included in the analysis. Exam of the results from these half dozen units yielded a contamination rate of 1.36%, with rates of 0, 0, 3.28, and 2.0% for PI, TI, IPA, and Persist, respectively. To further appraise the effect of noncompliance, contagion rates were recalculated by using data just from units with an estimated compliance rate in excess of 100%. These adjusted rates were very similar to those calculated by using information from all 29 units.
An estimate of the savings associated with the utilize of each of the three alcohol-containing antiseptics compared with the use of PI was calculated. The cost associated with PI was calculated past using the overall contamination rate observed with PI (including the baseline period and the PI arm of the study) and an clarified toll of $0.108 per culture. For the alcohol-containing products, the contagion charge per unit was calculated by combining the results of the three study arms that used these products. The calculated contamination rates were 3.15 and ii.51% for PI and the booze-containing antiseptics, respectively (P = 0.006). The average costs of each booze-containing antiseptic per civilisation were $0.0492, $0.525, and $0.58 for IPA, TI, and Persist, respectively. This analysis determined that the utilise of an alcohol-containing clarified would save this institution $326,109 (using Persist) to $332,846 (using IPA) per year fifty-fifty if the magnitude of departure in contagion rates was merely 0.64%, as seen in the nowadays report. Looking only at the toll of the antiseptic, the use of IPA would save betwixt $746.29 and $vi,736.91 per twelvemonth compared to the use of PI and Persist, respectively.
Give-and-take
The excess costs and diagnostic difficulties associated with contaminated blood cultures, likewise every bit the personal costs experienced by patients, make efforts to reduce contagion important. Cutaneous antiseptics are a major focus of these efforts. Several antiseptics take been used for this purpose, but relatively few comparisons of the efficacy of these products take been reported. Three studies take directly compared the commercially bachelor prepping agents (x, 18, 20), and iv others have compared prepping agents by unlike methods of application (7, 15) or by unspecified methods of application (half dozen, 16).
3 previous studies (seven, xvi, 20) found significantly lower rates of contamination with TI than with PI. The results of the present written report supported these findings by showing a relative reduction in claret culture contamination of xx% when TI was used during the study compared to the use of PI during the baseline menses (RR = 0.80, 95% CI = 0.62 to 1.02, P = 0.067). The contagion rate with TI was also lower than that observed with PI during the study (12% relative reduction), but the sample size of this report was not planned to detect a departure this modest every bit statistically significant.
This lack of sufficient power was due to lower-than-expected contamination rates. The rate of contamination with PI in the current study (ii.93%) was substantially lower than in two earlier prospective studies, in which PI contamination rates ranged from three.eight to 6.25% (seven, 20). The TI-associated rate of contamination in the current study was about the aforementioned or even lower than in the other studies (2.58% compared to two.four and iii.74%). This suggests that the similar contamination rates of PI and TI in the current written report were largely due to the lower contamination charge per unit with PI, possibly due to improved technique every bit a event of increased awareness of the importance of minimizing contamination in the setting of a written report and implementation of a specific phlebotomy protocol. In two of the 3 prior studies reporting the superiority of TI (16, 20), at that place was no standardized phlebotomy technique and no specified minimum interval between the application of antiseptic and performance of the phlebotomy. Without a specific protocol, it is unlikely that sufficient time was e'er allowed for PI to accept maximal activity, thus maximizing whatever differences between PI and a more rapidly acting antiseptic, such as TI.
Despite the unexpected limitation in statistical ability, at that place was show to suggest less contagion with alcohol-based antiseptics. This testify included the pregnant decrease in overall contamination rates during the study compared to the baseline period, the significantly lower contamination rate for the combined alcohol-containing antiseptic groups compared to the combined PI groups (baseline menstruation and PI study arm), and the absence of a significant divergence between contagion rates when PI was used during the study and baseline periods despite meaning differences betwixt the baseline PI contamination rate and the rates observed for IPA and Persist. The credible benefit of alcohol-containing antiseptics was likely due to their more than rapid antimicrobial activity compared to iodophors (4, 5, 13; Fifty. L. Fauerbach, M. J. Schoppman, V. R. Singh, L. S. Netardus, D. 50. Pickett, and J. Due west. Shands, Programme Abstr. 31st Intersci. Conf. Antimicrob. Agents Chemother., abstr. 1269, 1991).
The results of the present study are consistent with those of 2 earlier studies that demonstrated the equivalence of alcohol to iodine-containing antiseptics in preventing contamination of blood cultures. Lee et al. reported the equivalence of IPA and 2% tincture of iodine in 1967 (6). Subsequently, Shahar et al. (18) documented contamination rates of 4.4 and 3.3% with PI and alcohol, respectively (P = 0.39). The ability of that study to detect a meaning deviation betwixt the two antiseptics was limited by a minor sample size.
Recently, a solution of 0.5% chlorhexidine gluconate in 67% isopropyl booze was demonstrated to be superior to PI in preventing claret culture contamination (1.4% versus iii.three% contamination, respectively) (seven). It is possible that this was due to the alcohol component of the chlorhexidine solution rather than to the chlorhexidine itself since chlorhexidine has not been credited as beingness a rapidly acting antiseptic in most studies (eleven, 12). Thus, comparing of the efficacy and cost-effectiveness of this product to other alcohol-containing antiseptic preparations is warranted.
There are several other possible explanations, in addition to insufficient power, for the lack of a significant difference among the four antiseptics noted during the nowadays written report. This study was designed to minimize additional responsibilities or activities (such as documentation or labeling) required of healthcare workers in an endeavour to maximize participation. Thus, an intent-to-care for analysis was selected such that documentation of the antiseptic used for individual patients was not required. With this blazon of analysis, noncompliance with utilise of the study materials would result in a bias toward a lack of difference between PI and the other antiseptics. However, the likelihood of such noncompliance was reduced by moving nonstudy antiseptics to another location and past the group strategy. In addition, the estimated compliance with the use of study materials was high. The six units with poor compliance were among those where the smallest number of cultures were obtained and deemed for only ane.7% of cultures included in the analysis. When noncompliant units were excluded from the analysis, in that location was no modify in the results. Thus, noncompliance was unlikely to be responsible for the findings of this study.
The definition of contagion used in two earlier studies was likewise unlike from that used in the current study. Unlike the Strand study, the present study required a companion set of cultures that yielded no growth in society to include a civilisation growing common peel flora as a contaminant in the analysis. Thus, a number of potentially contaminated cultures were excluded. If companion cultures had not been required, a total of 233 (5.96%) of 2,909 emergency department cultures obtained during the baseline period would have been considered contaminated compared to iv.50% for PI and 4.14% for TI during the written report (P = 0.79). Again, no difference was detected between PI and TI during the study based on this definition.
A potential confounding factor in the current written report was the introduction of a 24-hour phlebotomy squad into the inpatient non-critical intendance units at the beginning of the second written report period (21). Prior to this, most of the cultures performed in these units had been obtained by resident physicians. The new phlebotomy team performed approximately four to eight sets per day, representing 10.5 to 21% of daily cultures. Nevertheless, the lack of divergence between the results of the first report period and the afterwards periods suggests that any confounding effect that occurred was minimal.
Application of the findings of this study on a national scale could result in a substantial savings for the U.S. healthcare system. An estimate of potential savings was calculated by using information from the Q-Probes programme of the Higher of American Pathologists (14). In 1989, ca. 800 participating healthcare facilities performed almost 170,000 blood cultures during a xxx-24-hour interval flow. If we assume that this period was representative of usual practices at these facilities, roughly ii million claret cultures would be performed annually at these facilities. If nosotros assume that these facilities are a representative sample of the ca. 6,000 hospitals in the Usa, an estimated fifteen million blood cultures would accept been performed in the state in that year. If similar trends continue at the nowadays time and the same cost analysis method used in the nowadays written report is practical to these data, the use of IPA rather than PI (which is the most commonly used antiseptic for this purpose nationwide) prior to phlebotomy for claret cultures would forbid ca. 96,000 contaminated blood cultures per year, with a resulting savings of $400 meg annually. If baseline contamination rates in many of these hospitals are actually higher than the estimates used in this analysis, then even greater cost savings could be achieved.
In conclusion, blood culture contagion rates ranged from two.46 to ii.93% during this study when povidone-iodine with alcohol (Persist), isopropyl alcohol, tincture of iodine, or povidone-iodine (P = 0.62) was used. There was, withal, evidence to suggest less contagion with the alcohol-based antiseptics. Given the demonstrated efficacies of these 4 antiseptics, their relative costs, the greater risk of cutaneous reactions with TI, and the potential to decrease costs by producing more than accurate results, IPA may be the optimal antiseptic for percutaneous blood cultures. Future investigations will be needed to directly compare isopropyl alcohol and other booze-containing antiseptics with chlorhexidine gluconate in the prevention of claret culture contamination.
Acknowledgments
Nosotros thank the staffs of the Academy of Virginia Hospital and Becton Dickinson, Sandy, Utah, for supplying report materials.
Fiscal support for this study was provided past Becton Dickinson, Sandy, Utah.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130950/
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