Improving awareness of blood culture indication, procedure and resource Utilization at Armed Forces Hospital Jizan, Saudi Arabia

Blood culture contamination (BCC) is a significant quality and safety issue in hospitals, as it leads to increase in unnecessary testing, admissions, antibiotic exposure and cost. This study is the first study on the BCC rates in Armed Forces Hospital Jizan (AFHJ), Saudi Arabia. The main goal of our quality improvement (QI) project was to reduce BCC rate in AFHJ from 7.5% to international benchmark (<3%) after January 2021 as well as to reduce the negativity rate. This study was conducted in AFHJ (KSA) including two major steps: first, development and implementation of QI interventions to reduce BCC and negativity rate in the AFHJ. Second, evaluation of the effectiveness of these interventions. The intervention was developed through QI methodologies, including fishbone diagramming and the plan-do-study-act cycle. Intervention effectiveness was evaluated using an interrupted time series analysis. Clear survey questionnaires were made and distributed to participants to get preaudit results.Then we started the education programme depending on the preaudit results. Soft copy of written steps of blood collection procedure and indication was done and sent to nurses and physicians. After that, direct observations of nurses involved in the process were conducted. Finally, post-training assessment using previous survey questionnaires was performed to get postaudit results. During the baseline period (preintervention period), 7.5% from blood culture were contaminated, compared with 1.8% during the intervention period (postintervention period). Rate of negative blood culture was reduced from 96% to 91%. Overall improvement of knowledge and awareness of the nurses and physicians clearly noted after intervention implementation. Fortunately, we have noted that the budget of microbiology would be reduced by 10%-12% as a result of our interventions. By standardising blood culture collection methods, optimising blood volume and nurses' education, we were able to develop a best practice for blood culture collection and to reduce BCC and negativity rate to a sustainable low rate at our hospital.