TABLE 3.

Consideration for a blood culture improvement program

Consideration	Example of activity
Activities focused on the decision to order blood cultures
Do baseline assessment of blood culture practices.	Audit 15–30 blood cultures in the ICU and non-ICU to characterize most common inappropriate indications locally.
Educate bedside staff on appropriate blood culture indications.	This can use already developed clinical decision tools.
	This can use examples from audits of real cases.
Develop/implement clinical guidance regarding appropriate blood cultures.	Consider starting with the “low hanging fruit” (limiting repeat blood cultures to document clearance of bacteremia and limiting repeat blood cultures for persistent fever/leukocytosis if there are previous negative blood cultures).
	Implement blood culture ordering recommendations at the point of care and consider building these recommendations in the electronic medical record (EMR).
Use a quality improvement framework.	The Plan-Do-Study-Act is a simple approach to improve practices, which includes evaluating the impact of a new intervention (e.g., new recommendations for blood culture indications on blood culture positivity) and collecting and providing feedback.
Make the blood culture improvement program a hospital priority and engage multiple stakeholders.	Involve multiple groups, such as vascular access teams (nursing and interventional radiology), pharmacy, and nutrition.
	Review policies and protocols that have recommendations for blood cultures.
Activities focused on the blood culture collection process
Do baseline assessment of blood culture quality indicators.	Review blood culture quality indicator(s) already collected by the microbiology laboratory.
	Make comparisons with similar units (e.g., single blood culture for 2 medical ICUs).
Educate phlebotomy and non-phlebotomy personnel on preanalytical parameters that affect blood culture sensitivity.	If data are available, provide feedback to both unit leadership and frontline staff regarding blood culture positivity, single blood cultures, central line blood cultures, and blood culture contamination rates.
Assess barriers to improve practices.	Interview staff involved in collecting blood cultures.
	Target the survey based on blood culture quality indicator data.
	Consider observing how blood cultures are being performed to identify additional barriers to improving practices.