Reducing Blood Culture Contamination in Emergency Department through an Educational Nursing Program

1. Reducing Blood Culture Contamination in
Emergency Department Through an
Educational Nursing Program
Wilfredo Ebreo Maan
College of Arts and Science
Department of Nursing
Lamar University
MSNC 5311 Fall 2016

2. Blood cultures are considered the “gold standard” and
the most sensitive method for the detection and diagnosis
of bacteremia (Hall & Lyman, 2006, p.789).

3. Purpose of the Study
To reduce blood culture contamination in Emergency
Department through an educational nursing program.

4. Significance of the Study
Retrospective data analysis through an initial audit with
other major department showed that the contamination
rate for blood cultures in our emergency department was
4.8% which is more than the set standard (i.e. less than
3%).

5. Understanding the contamination rate in our emergency
department, which if elevated, will give me the opportunity
to improve the following: patient care/patient
safety/patient satisfaction and this study supported action
to demonstrate a cost-effective solution for the institution.

6. Statement of the Research Problem
Health care providers rely heavily on blood culture
results for developing patient’s plan of care. Contaminated
blood cultures can lead to unnecessary treatment,
hospitalization, and an increase in the patient’s length of
stay (Dawson, 2014).

7. Conceptual Framework
A conceptual model provides a coherent, unified and orderly
way of envisioning related events or processes relating to
discipline (Fawcett, 2005). The most common use of the
conceptual model is to provide an organizing structure for the
research design and methods. A second purpose is to guide the
development and testing of interventions and hypotheses based
on the tenets of the theory. A third function is to explain the
study results and place the findings within the context of science
in a particular field of investigation. The interpretations of
results flow from the conceptualization represented by the
framework (Radwin & Fawcett, 2002, Polit & Beck, 2012).

8. Stufflebeam et al. proposed a model designed to help
evaluators generate relevant information that is useful to
the decision maker (Stufflebeam, Madaus, & Kellaghaun,
2002). This model guides and assists program evaluators
throughout the design, development, and use of the
evaluation. Stufflebeam et al.’s model is frequently referred
to as the context, input, process product (CIPP) model.

10. Brief Literature Review
Contaminated blood cultures can increase patient’s
hospital stay by as much as 4.5 days and add more than
$5000 to the cost of treatment (Robert, 2011).
Contaminated blood cultures could keep patients from
rejoining their families and their jobs and from reclaiming
their daily lives (Ernst, 2004).

11. Aronson and Bor found out that blood culture
contamination is a widespread problem, with potentially up
to 50% of all positives cultures testing positive due to the
presence of contaminants.
A study by Shekar et al. has shown that trained phlebotomist
or blood-culture teams can reduce contamination rates in an
individual institution.

12. Research Question
Does an educational nursing program decrease blood
culture contamination rate in emergency department?

13. Research Design
Quantitative research is most often about the
quantifying relationship between or among variables – the
independent or predictor variable and the dependent or
outcome variable. This study will utilize Quasi-
experimental design which will examine the cause-and-
effect relationship between independent and dependent
variable (Burns & Grove, 2007).

14. Assumptions, Limitations, and Delimitations
In conducting this study, it was assumed that respondents
would utilize the gain knowledge, skills and technique of
drawing blood culture specimen after attending the
educational nursing program. With this education nursing
program, it is assumed that it will decrease the contamination
rate in the department.

15. Limitations of this study included the fact the study is
confined to a 35-bed emergency center (EC) of a Level III
hospital on the East side of Houston. The sample size will
be limited and restricted to only one hospital.

16. The participants of this study will include full time, part
time, and PRN Registered Nurses who are employed by this
facility and has attended the Nursing Orientation program
Blood Collection Protocol during the new hire orientation
week as well as the 2-day class which will be provided by
the EC Nurse Educator.

17. Sample
The study will be conducted in a 35-bed emergency
center in a Level III trauma hospital in Houston with
approximately 70,000 patient visits per year. Each month,
on average the EC takes 900 sets of blood culture
collection.

18. Plan for Data Analysis
Based on the level of measurement and number of variables,
one of the statistical models that apply to this study is analysis of
variance (ANOVA) (Burns & Grove, 2007).
The Pearson correlation coefficient r can take a range of
values from +1 to -1. A value of 0 indicates that there is no
association between the two variables (Burns & Grove, 2007).
Bivariate analysis is one of the simplest forms of quantitative
statistical analysis. It involves the analysis of two variables
(dependent and independent) for the purpose of determining
the empirical relationship between them (Burns & Grove, 2007).

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