Effectiveness of practices to reduce blood culture contamination: A Laboratory Medicine Best Practices systematic review and meta-analysis

ObjectivesThis article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits.Design and methodsThe CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used.ResultsStudies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12).ConclusionsVenipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based “best practices” with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement.

► Systematic review of practices for reducing blood culture contamination.
► Venipuncture and phlebotomy teams are effective for reducing contamination.
► Venipuncture and phlebotomy teams are recommended evidence-based “best practices”.
► Evidence reviewed for prep kit effectiveness did not support a recommendation.