Reduction of Skin Flora in Blood Cultures from Patients on an Oncology Unit in a Large Acute Care Hospital

BACKGROUND/OBJECTIVES: Electronic surveillance capabilites began at our 453 bed acute care hospital in June of 2005. The availability of searchable laboratory and census data allowed us to aggregate data by specific source, organism and location of collection. METHODS: A house-wide search for isolates from all patients with a length of stay of three days or longer was performed for June through August 2005. We found that the third highest incidence was blood isolates. When we aggregated blood sources separately we noted that the unit with the highest incidence was our Hematology/Oncology unit. Additionally we noted that 68% of the blood isolates were probable skin flora. We then directed interventions to this group of organisms. Visits to the Oncology unit revealed a lack of uniform practices for prepping prior to blood draws, and inconsistencies in accessing IV lines. The unit nurse manager instructed staff in blood culture prep technique. The practitioner responsible for PICC line insertion was enlisted to assist in policy revision and staff education. RESULTS: After interventions, subsequent results during the months of October through December 2005 demonstrated a 50% decrease in the overall number of isolates from patients on Oncology with a 26% decrease in isolates of skin flora. Patient days remained unchanged over the entire period. CONCLUSIONS: The ability to conduct surveillance beyond those units included in conventional surveillance models allows for prompt identification of areas where basic interventions can improve the quality of patient care. The presence of a positive blood culture in this very high risk population mandates antibiotic treatment. Many organisms generally regarded as evidence of contamination may actually be an infection in extremely compromised individuals, therefore improved techniques for acquiring blood specimens for culture will reduce antibiotic exposure for this population.