Use of the non-wire central line hub to reduce blood culture contamination.
Chest. 2012 Sep 3;
Authors: Levin PD, Moss J, Stohl S, Fried E, Cohen MJ, Sprung CL, Benenson S
Abstract
ABSTRACT BACKGROUND: The sterile conditions employed when inserting a central venous catheter (CVC) might be thought to decrease the contamination rate of blood cultures taken at CVC insertion, however a previous retrospective study showed the opposite - that such blood cultures are contaminated more frequently than peripheral venipuncture blood cultures. The current study explored whether use of the CVC non wire hub as a source of blood cultures decreased contamination, while maintaining detection of true pathogens. METHODS: A prospective observational study performed from June 2010 to May 2011 in the general ICU of academic tertiary referral center. The proportions of blood cultures taken from wire and non-wire CVC hubs growing contaminants and true pathogens were compared. Risk factors for blood culture contamination were identified, and multivariate analysis used to identify independent predictors of blood culture contamination. RESULTS: Amongst 313 blood cultures taken from 227 CVCs in 139 patients 27/141 (19%) wire hub vs 9/172 (5%) non-wire hub cultures were contaminated (p<0.001). Only hub of blood culture origin was associated with contamination on multivariate analysis (OR 4.3, 95%CI 1.9-9.5, p<0.001). True pathogens grew in 19/141 (13%) wire hub vs 27/172 (16%) non-wire hub cultures (p=0.581). CONCLUSIONS: A higher proportion of blood cultures taken from the CVC lumen exposed to the guide-wire were contaminated when to compared to non-wire hub cultures while detection of true pathogens was equivalent. To limit detrimental sequellae of blood culture contamination blood cultures obtained at CVC insertion should be taken from the non-wire hub.Departments of (1)Anesthesiology and Critical Care Medicine,(2)Clinical Microbiology & Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel and(3)The Hebrew University, Jerusalem, Israel.Address for correspondence: Dr Phillip D Levin, Dept of Anesthesiology and Critical Care Medicine, POB 12000, Jerusalem 91120, Israel Email: phillipl@hadassah.org.ilNo financial support was received for the performance of this study.
PMID: 23187312 [PubMed - as supplied by publisher]