Collection of Blood Cultures
Tracy
Evidence Based Practice for The Baccalaureate Prepared Nurse
Abstract Proper collection of blood cultures are necessary and the most direct method of determining whether or not a patient is septic. The purpose of obtaining blood cultures is to identify and isolate the bacteria that are causing an illness and then determine the best course of treatment based on the sensitivity of the bacteria to particular antibiotics. One of the most frustrating problems plaguing hospitals is the increased rate at which blood culture results are being returned as contaminated specimens. These results can lead to a significant increase in cost to the hospital and patient as well as an increased length in hospital
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A total of 5,432 blood cultures were obtained from 2,642 patients and a significantly lower rate of contamination were seen in those specimens obtained by a dedicated phlebotomist. The phlebotomist collected cultures had a contamination rate of 2.4-3.6%, with an overall rate of 3.1% and the non-phlebotomy collected cultures showed contamination rates 6.2-10.2%, with an overall rate of 7.4% (Gander et al., 2009). The difference in the median patient charges between the negative ($18,752) and false-positive cultures ($27,472) resulted in additional charges totaling $8,720 for each contaminated event (Gander et al., 2009). The median increase for length of stay only increased from 4 days (negative culture) to 5 days (false-positive culture); whereas, patient’s with significant bacteremia had an additional median charge of $32,303 and 8-day median length of stay (Gander et al., 2009). This study goes on to state that with the estimated $8,720 for each episode of a contaminated blood culture, the prevention of only five contaminated blood cultures a year might fund the yearly salary for one dedicated phlebotomist in the ED and could potentially save the hospital $4.1 million in excess charges annually (Gander et al., 2009). This literature precisely defines reasonable need for correct collection of blood cultures in the emergency setting and provides evidence for former PICOT question.
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Hospital acquired infections (HAI) will begin to display signs and symptoms within 48 hours. In order to treat the infections, physicians need to diagnostic tools quickly. The manufacturer of new diagnostic test makers, Kalorama Information stated last year that the world demand for testing and treatment of HAI will be over 10 billion dollars by the year 2015, increasing from 9 billion dollars in 2010. Kalorama also stated that HAI has a 5% infection rate of 40 million hospital visits a year, causing 100,000 deaths in the U.S. annually (Kalorama Information, July 14, 2011). Early diagnosis will improve the patient's outcome and decrease the chance of death. According to Kalorama, 20-30% of the HAI can be prevented by the simple use of better hand washing and cross contamination avoidance although the others need more intensive changes such as hospital ventilation systems and using more disposable supplies (Kalorama Information, p. 113) .
Venous thromboembolism refers to the formation of a blood clot in a blood vessel. While clots can form in an artery or a vein, this article focuses only on clots that occur in a vein ("," 2015). Critically ill patients are at an increased risk of a venous thromboembolism (VTE) due to VTE can manifest as a deep venous thrombosis (DVT) or a pulmonary embolism (PE). Risk factors include venous stasis, vascular injury, and hypercoagulable disorders. A majority of ICU patients carry at least one risk factor for VTE; additional risk factors are considered to have a cumulative effect…it is impossible to predict which patients will experience a
Jeremy, nice posting about continuing to advance evidence-based practice (EBP). Stevens (2013) wrote that clinical leaders have the chance to advance ahead and change healthcare from a systems view, thus directing their efforts on evidence-based practice (EBP) for proven effectiveness, patient commitment, and patient safety. I see that through this program that this is only the beginning, I have the sturdy foundation from which I can build from the bottom up. Now that my eyes are open more and I challenge the organization or leaders more with the data to support my claims, I am now the squeaky wheel that grates on your nerves.
Checking in to the hospital comes with a heavy price tag, and sometimes you get more than what you bargained for. As highly trained doctors, nurses, and staff make their way through the hospital, they carry with them microbial agents of disease. Although regarded as centers for treatment and prevention, hospitals are also known to harbor nosocomial, healthcare-associated, bacterial infections. These infections can be a result of overused or inappropriately used antibiotics and the breaching of infection containment policies by patients and staff. Though health-care-associated infections have been decreasing, one infection inciting nosocomial bacterial, Clostridium difficile has been rampant. It is important that inefficiencies in health-care be met with stringent efforts for prevention as they may lead to distressing financial, emotional, and medical repercussions.
The purpose of this essay will be to discuss evidence based practise and its use in nursing, I will be discussing, the types of research and various forms of data, including the principles of evidence based practise and research. Evidence Based practice is finding the most effective, research proven, evidence to make decisions regarding the service users individual needs and the best decisions for them. As David Sackett quotes, "evidence based practise is the integration of best research evidence with clinical expertise and patient values." (Sackett D, et al 1996, p.71) Evidence based practice is good practice, assist practitioners, avoiding information overload and applying the most useful information.
Blood culture (BC) contamination is a common, yet preventable problem for emergency departments (EDs) across the country (Self et al., 2014). Erlanger Hospital’s ED is no different and being the region’s only Level 1 Trauma Center, it is called to an excellent standard of practice. BC testing is a routinely applied intervention used to diagnose infections in symptomatic patients who arrive at the ED (Denno & Gannon, 2013). BCs are essential as they help identify accurate pathogens and provide targeted antibiotic therapy (Denno & Gannon, 2013). They are often viewed as the standard for diagnosing illnesses such as septicemia and other
The purpose of this paper is to answer questions which surround the topic of evidence based practice (EBP) in Social Work. This paper will discuss the definition of EBP, why EBP is used in Social Work, the positive and negative sides of EBP, and finally an example of EBP being used within an agency setting. The information gathered is coming from three separate scholarly journal articles, a podcast episode, and the National Association of Social Workers Code of Ethics (NASW Code).
In today 's society, there is a great deal of research and practice about evidence based practice. Most of this is highly sought upon in the field of psychology, where evidence and decision making is key to accomplishing new ideas of treatments for people who retain psychiatric problems. The meaning of evidence-based practice in psychology is that it involves making very educated and supported decisions based on punctilious, unambiguous, and astute evidence (Rousseau & Gunia, 2016). With evidence-based practice, it assists in raising and deriving the issue of what evidence really is, the strength of the evidence, and how practitioners can improve the quality of their evidence (Rousseau & Gunia, 2016). Evidence is a major factor because
Evidence-based practice (EBP) centers around using the current, best evidence available to make patient care decisions. EBP solves issues and problems by searching for the most relevant evidence available and critically appraising it. It then takes into account one’s own clinical expertise, as well as patient values and preferences (Academy of Medical-Surgical Nurses, 2017). The goal of evidence-based practice is to provide optimal clinical service while treating the patient as an individual (American Speech-Language-Hearing Association, 2017).
Checking in to the hospital comes with a heavy price tag, and sometimes you get more than what you bargained for. As highly trained doctors, nurses, and staff traverse through the hospital, they carry with them microbial agents of disease. Although regarded as centers for treatment and prevention, hospitals are also known to harbor nosocomial, healthcare-associated, bacterial infections. These infections can be a result of overused or inappropriately used antibiotics and the breaching of infection containment policies by patients and staff. Though healthcare-associated infections have been decreasing, one infection inciting nosocomial bacterium,
There is an abundance of information identifying central line acquired bloodstream infection (CLABSI) as a serious adverse event during hospitalization resulting in increased morbidity, mortality, and health care cost. Present data from research indicates that CLABSI is the second most avoidable cause of death during hospitalization (Shah, Schwartz, & Cullen, 2016). The above concepts that CLABSI is preventable yet it continues to yield a yearly cost of 2.3 billion dollars and remains a quality metric for national offices such as Joint Commission indicates a foundation for research (Son et al., 2012). Upon the literature review, CLABSI rates were significantly reduced when specific techniques were implemented. Furthermore, all the articles
The CDC’s National Healthcare Safety Network (NHSN) supports 2,000 hospitals nationally (Central line-associated bloodstream infections, n.d.). Since March 2010, hospitals, in twenty one of the United States’ fifty states, are required to report their hospital acquired infections to the NHSN (Central line-associated bloodstream infections, n.d.). The CMS data report includes identification numbers for the hospitals the CLABSI happened at, the name and address of the hospitals, the number days the central line was in, the number of CLABSI incidences the hospitals had, and each hospitals’ National Healthcare Safety Network standardized infection ratio (SIR) (Tabak et al.,
Huang, S.S. (2014). Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial. Infection Control & Hospital Epidemiology, 35, 17-22. doi
“Infections were identified using previously validated computerized algorithms” (Cohen et al., 2013). Cases of bloodstream infections were patients who had a positive blood culture in the presence of a negative culture for the same organism in another body site within the previous 2 weeks (Cohen et al., 2013). Cases of surgical site infections were patients who had a surgical procedure as demonstrated by an ICD-9 code and a positive surgical wound culture within 30 days after surgery (Cohen et al., 2013). For community-associated infections, data including age, gender, diagnoses, health history, and hospital admissions were identified. For hospital-associated infection, data including hospital admissions, ICD-9 codes, EMRs, MARs, and pre- and
Blood-stream infections affect more than 700,000 in the U.S. resulting in a healthcare cost of $20 billion annually. The current standard is to administer multiple general antibiotics first, followed by a blood culture to identify the infecting bacteria. This method takes days and puts the patient at risk because these general antibiotics are not often effective due to the rise of antibiotic-resistant bacteria. Doctors overmedicate hospital patients due to the wait time for infection analysis. This excessive medication has led to the deaths of patients. Instead of doing lab analysis, the rapid diagnostic device receive the blood sample, analyze whether the type of infection, and report the effective medications. This would prevent the prescription