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					                          Blood Culture Policy




EQUALITY IMPACT
The Trust strives to ensure equality of opportunity for all both as a major employer
and as a provider of health care. This policy has therefore been equality impact
assessed by the Infection Control Committee to ensure fairness and consistency for
all those covered by it regardless of their individual differences, and the results are
shown in Appendix 1.

                   Version:               1.2
                   Authorised by:         Infection Control Committee
                   Date authorised:       06/06/08
                   Next review date:      06/10/08
                   Document author:       Angela Hallas
TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                           Blood Culture Policy




VERSION CONTROL SCHEDULE
Blood Culture Policy

Version : 1.2

  Version Number             Issue Date              Revisions from previous issue
  1.1                        June 2008               First issue
  1.2                        June 2009               Addition on Policy Itself re peripheral
                                                     sites:-
                                                     Suitable Site
                                                     Procedure




 VERSION 1.2 June 2009                                                                   Page 2 of 11
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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                                                   Blood Culture Policy



INDEX/ TABLE OF CONTENTS
EQUALITY IMPACT ................................................................................................... 1
INTRODUCTION ........................................................................................................ 4
PURPOSE/RATIONALE/OBJECTIVES ..................................................................... 4
SCOPE ....................................................................................................................... 4
DEFINITIONS............................................................................................................. 4
DUTIES ...................................................................................................................... 5
POLICY STATEMENT................................................................................................ 6
THE POLICY ITSELF ................................................................................................. 6
  Indications for taking blood cultures........................................................................ 6
  Timing of the blood culture...................................................................................... 7
  Procedure ............................................................................................................... 7
POLICY DEVELOPMENT & CONSULTATION .......................................................... 9
IMPLEMENTATION.................................................................................................... 9
MONITORING ............................................................................................................ 9
REFERENCES ........................................................................................................... 9
REVIEW ................................................................................................................... 10
APPENDICES .......................................................................................................... 11
  Appendix 1 ............................................................................................................ 11




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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy




INTRODUCTION
The culture of micro-organisms from blood is essential in the laboratory diagnosis of
bacteraemia and many infective conditions associated with a clinical presentation of
pyrexia of unknown origin. It is also an important component of the diagnosis of
prosthetic material infections. Blood cultures may also detect bacteraemia in
association with other infectious diseases such as septic arthritis and pneumonia.
Early positive results provide valuable diagnostic information on which appropriate
antimicrobial therapy can be based, thus helping to reduce morbidity and mortality. It
is therefore essential that blood for culture is correctly collected to avoid
contamination of the specimen.
This policy presents recommendations that when followed will improve the quality
and clinical value of blood culture investigations and reduce the incidence of sample
contamination and ‘false positive’ readings when taking blood cultures.
This will help improve patient care and reduce the number of wrongly reported
infections. By following this policy staff will take blood cultures only when there is a
clinical need to do so, blood cultures should not be taken as a matter of routine.


PURPOSE/RATIONALE/OBJECTIVES
The aim of this policy is to ensure that blood cultures are taken:
   • For the correct indication
   • At the correct time
   • Using correct technique in order to prevent contamination of the sample.
   • Minimizing risk to patients or staff
   • Ensuring correct documentation


SCOPE
This policy applies to all medical staff and healthcare staff who have undertaken
training in the collection of blood cultures. It is a medical decision to take or request a
blood culture in response to at least two of the signs/ symptoms present and new to
the patient, and infection/ sepsis are suspected. Staff should also refer to the Clinical
Guidelines for Septicaemia.


DEFINITIONS
Blood cultures are taken to identify patients with bacteraemia (blood stream
infections) there are many signs and symptoms in a patient which may suggest
bacteraemia and clinical judgement is required.




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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy


DUTIES
Chief Executive
The Chief Executive has overall responsibility and is accountable for ensuring that
there is a managed environment which minimises the risk of infection to patients,
visitors and staff .

Director of Infection Control
The Director of Nursing is the Chief Executives nominated Director for Infection
Prevention /Control and is responsible for ensuring that there are effective and
appropriate arrangements for the prevention and control of infection throughout the
Trust.

The Infection Prevention/Control Team
The Infection Control Team report directly to the Director Of Infection Control and are
responsible for aspects of surveillance, prevention and control of infection within the
Trust. The Infection Control Team are responsible for the implementation of the
Trust’s Infection Prevention/ Control programme and for the development and
dissemination of policies, guidelines and procedures.The Infection Control Team are
responsible for the initial investigation of a positive MRSA Bacteraemia and ensure
the subsequent investigation through root cause analysis within 72 hours.

Microbiology Laboratory
The microbiology staff support the Infection Control Team by processing
microbiological specimens, providing immediate notification of an MRSA
bacteraemia, this allows prompt identification of infection and subsequent
investigation and treatment.

Directors / Lead Clinicians / Senior Managers
All Directors, Lead Clinicians and Senior Managers have delegated responsibility for
ensuring that this policy is known to their staff and that its requirements are followed
by all staff within their Directorate / Division / Department.

Departmental Heads / Service Managers / Clinical Leads
Are responsible for ensuring infection control risk assessments are undertaken and
that all possible measures are taken to reduce the spread of infection to patients,
visitors and staff.
All managers are responsible for ensuring that staff have access to up to date
training to enable them to adopt safe working practices at all times and are
appropriately trained to minimise risks to themselves and others.

All Staff
All staff are responsible for following the Blood Culture Policy. Blood cultures should
only be collected by members of staff who have been trained in the collection
procedure.




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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy


POLICY STATEMENT
There has been little consistent or definitive advice to the NHS on how and when to
take blood cultures and how to best avoid sample contamination. There is also
variation in practice amongst NHS staff in taking blood for culture and following this
policy ensures practice is consistent and contamination is reduced.
 Carelessly collected blood cultures are often contaminated with bacteria of the
normal skin flora of the patient or the blood culture taker and can lead to false
positive results . This complicates patient care and artifically raises the incidence rate
of infection.
The essential components to ensure appropriate blood culture collection are:
    • Only take a blood culture if there is a clinical need to do so not as routine.
    • Staff are competent and trained
    • Maintain asepsis throughout the procedure


THE POLICY ITSELF

Indications for taking blood cultures
Only take blood for culture when there is a clinical need to do so and not as
routine.
Blood cultures are taken to identify patients with bacteraemia. There are many signs
and symptoms in a patient which may suggest bacteraemia and clinical judgement is
required. The following indicators should be taken into account when assessing a
patient for signs of bacteraemia or sepsis:

   •    Core temperature out of normal range > 38.3 C / < 36 C
   •    Abnormal heart rate (raised) >90
   •    Low blood pressure Systolic BP < 90 mmHg / fall of 40 mmHg from patients
        normal
   •    Raised respiratory rate >20 breaths per minute

   Other signs and symptoms include:
   • Neutrophilia,or neutropenia ( WCC > 12,000 < 4000 units)
   • Chills with rigors; headache with stiff neck
   • New or worsening confusion

   Additional Paediatric Indications
   • Toxic appearance including lethargy
   • Decreased Glasgow coma scale
   • Increase capillary refill time
   • Increased pulse and respiratory rates
   • Thrombocytopenia in neonates

   NB. Signs of sepsis may be minimal or absent in the very young and the
   elderly.

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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy



Timing of the blood culture

   •    Blood cultures should be taken as soon as possible after identification of likely
        Sepsis.
   •    Blood cultures should ideally be taken prior to the administration of antibiotics.
   •    In a patient on antibiotics, blood cultures should be taken immediately before
        the next antibiotic dose, with the exception of paediatrics where the blood
        culture would be taken immediately without waiting for the next regular dose.
   •    In patients with bacteraemia (but not endocarditis) 80% of blood cultures will
        be positive. This rate increases to 90-95% with two cultures. Therefore it is
        recommended that two sets of cultures are taken at separate times from
        separate sites.
   •    In endocarditis it is recommended to take three sets of blood cultures.

Suitable Sites
   •    Site of choice are the veins of the antecubital fossa and the hand veins
   •    Do not use existing venflons or sites immediately above these, always make a
        fresh peripheral stab.
        (If a central line is present, blood may be taken from this and from a separaate
        peripheral site when investigating potential infection related to the central line;
        the peripheral vein sample should be collected first).
   •    The femoral vein must only be used as a last resort due to the risk of
        contamination. Only a doctor should carry this out. Femoral veins are also a
        last resort in paediatrics, particularly neonates where there is a risk of
        puncturing the hip capsule.

  Equipment

   • Equipment required

            1. S- Monovette blood culture collection system
            2. Chloraprep Frepp1.5ml ( 2% Chlorahexidine Gluconate in 70%
               Isopropyl Alcohol ) one step single use device
            3. Mediswabs ( 2% chlorahexidine gluconate in 70% isopropyl alcohol )
            4. Tourniquet
            5. Gloves
            6. Dressing

Procedure
This procedure must only be carried out by those staff who have received training in
blood culture collection. An aseptic technique should be used.
   • Prepare the environment and assist the patient into a comfortable suitable
       position for the procedure.
   • Wash your hands with soap and water and then dry.
   • Take the above equipment to the patient on a clean plastic tray (cleaned with
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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy

        detergent wipes or soap and water dried and then cleaned with a PDI medical
        device wipe 2% chlorahexidine gluconate in 70% isopropyl alcohol and allow
        to dry).
   •    Identify the patient using reliable and accurate information i.e. name band and
        verbal identification were possible.
   •    Explain the procedure.
   •    Clean visibly soiled skin on the patient with soap and water and then dry.
   •    Decontaminate hands again and apply clean gloves (sterile gloves are not
        necessary).
   •    Clean the tops of the blood culture bottles with a separate Mediswab (2%
        Chlorahexidine in 70% isopropyl alcohol).
   •    Apply a tourniquet if applicable to identify a vein.
   •    Decontaminate the skin using a Frepp (2% chlorahexidine gluconate in 70%
        isopropyl alcohol) using a friction scrub technique for 30 seconds and allow
        to dry.
   •    Identify a suitable venepuncture site before disinfecting the skin. Always make
        a fresh peripheral stab. Insert the needle/butterfly using a non –touch
        technique .Do not palpate again after cleaning.
   •    Following the principles of Aseptic non Touch Technique ( ANTT )
        perform venepuncture.
   •    All patients with suspected sepsis should have 2 sets of blood cultures taken
        This should be taken from separate sites at separate times.
   •    Ensure that the blood culture bottle is held upright when filling with blood .
   •    Flip blood culture bottle caps to reveal membranes disinfect the membrane of
        the blood culture bottles using a PDI medical device wipe 2% chlorahexidine
        gluconate in 70% isopropyl alcohol and allow to dry.
   •    Collect 20mls of blood for adults and 2-3 mls for paediatrics per blood culture
        set.
   •    Cover the puncture site with an appropriate dressing.
   •    Discard needle and syringe in a sharps container.
   •    Wash hands after removing gloves.
   •    Blood cultures should be delivered promptly to the laboratory.
   •    In the medical notes use a dated and timed entry to note indication for culture,
        site of venepuncture and any complications along with current or intended
        antibiotics.




 VERSION 1.2 June 2009                                                              Page 8 of 11
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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy




POLICY DEVELOPMENT & CONSULTATION
This policy has been considered by the Infection Control Committee and has been
ratified for implementation throughout the Trust. All stakeholders are represented on
the Infection Control Committee.


IMPLEMENTATION
This policy will be implemented throughout Tameside Hospital NHS Foundation
Trust. The policy will be displayed on the intranet. Staff awareness will be raised
during annual mandatory updates (all clinical staff including medical staff) and via the
Infection Control Link Nurse System. The policy will also form an integral part of the
existing Infection Prevention /Control Course for qualified and support staff and will
be part of the Venepuncture course.



MONITORING
Where monitoring has identified deficiencies, recommendations and action plans will
be developed and changes implemented accordingly. Progress on these will be
reported to the Infection Control Committee.

REFERENCES
Department of Health.(2007). Saving Lives : reducing infection,delivering clean and
safe care.www.clean-safe-care.nhs.uk.

Dulak,S.(2006). Obtaining blood cultures. Healthcare Traveller,13(10), ProQuest
Nursing Journals.

Ernst,D.J.(2001). The right way to do blood cultures . Medical Economics Publishing
Co, 64(3), 28-32.

Levt,M.M.etal.(2003).SCCM/ESICM/ACCP/ATS/SIS.(2001).SCCM/ESICM/ACCP/AT
S/SIS.International Sepsis Definitions Conference.Critical Care Medicine,31(4),1250-
6.

Lynn,W.A.(2000). Mechanisms and detection of bacteraemia.Journal of Royal
College of Physicans of London, 34(6), 536-540.

Madeo,M.et al.(2005). Simple measures to reduce the rate of contmination of blood
cultures in Accident and Emergency.Emergency Medicine Journal, 22, 810-811.

Spitalnic.S.J.(1995). The significance of changing needles when inoculating blood
cultures: a meta-analysis. Clinical Infectious Disease, 21(5), 1103-6

Weinstein, M.P. (2003). Blood culture contamination: persiting problems and partial
progress.Journal of Clinical Microbiology, June 2003, 2275-2278.

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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                      Blood Culture Policy



Weinstein,M.P.,Reller,L.B.,Murphy,J.R.,Lichtenstein,K.A.(1983). The clinicla
significance of positive blood cultures : a comprehensive analysis of 500 episodes of
bacteraemia and fungemia in adults.


REVIEW
This policy will be formally reviewed in April 2010, or earlier depending on the results
of monitoring.




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TAMESIDE HOSPITAL NHS FOUNDATION TRUST                                                          Blood Culture Policy




APPENDICES

Appendix 1

Appendix 1 Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the
appropriate committee for consideration and approval.

                                                                  Yes/No                   Comments

 1.    Does the policy/guidance affect one group                     No
       less or more favourably than another on the
       basis of:

 1.    Does the policy/guidance affect one group                     No
       less or more favourably than another on the
       basis of:

       • Race                                                        No

       • Ethnic origins       (including   gypsies      and          No
         travellers)

       • Nationality                                                 No

       • Gender                                                      No

       • Culture                                                     No

       • Religion or belief                                          No

       • Sexual orientation including lesbian, gay                   No
         and bisexual people

       • Age                                                         No

       • Disability - learning disabilities, physical                No
         disability, sensory impairment and mental
         health problems
 2.    Is there any evidence that some groups are                    No
       affected differently?
 3.    If you have identified potential                              No          There is no discrimination in
       discrimination, are any exceptions valid,                                 this guidance
       legal and/or justifiable?
 4.    Is the impact of the policy/guidance likely to                No
       be negative?
 5.    If so can the impact be avoided?                              N/a
 6.    What alternatives are there to achieving the                  N/a
       policy/guidance without the impact?
 7.    Can we reduce the impact by taking                            N/a
       different action?


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