Key points
- Proper collection prevents misdiagnosis and delays in treatment for bloodstream infections.
- New measure endorsed by a CMS Consensus-Based Entity (CBE) enhances diagnostic practices and reduces errors.
- Protect patients during the diagnostic process by monitoring adult blood culture contamination and single-set blood culture rates.
Why it is important
Laboratory analysis of blood cultures is vital to the accurate and timely diagnosis of bloodstream infections. However, the reliability of your testing depends on clinical compliance with collection procedures that limit the risk of inconclusive or incorrect results.
False negative blood culture results due to inadequate volumes of blood can:
- Result in misdiagnosis.
- Delay therapy.
- Put patients at heightened risk of morbidity and mortality from bacteria in the blood (bacteremia).
Likewise, the presence of commonly occurring bacteria or fungi on human skin (i.e., commensal organisms) can increase the risk of false positives and compromise care.
False positive blood culture results due to improperly collected blood cultures can lead to:
- Unnecessary antibiotic therapy.
- Prolonged hospitalization.
Quality measure
In December 2022, a Centers for Medicare & Medicaid Services (CMS) Consensus-Based Entity (CBE) endorsed a Centers for Disease Control and Prevention (CDC) proposal for a new patient safety measure to address these concerns (visit the CMS Quality Measures page for more on this topic). CDC developed this quality measure to promote blood culture best practices and improve the laboratory diagnosis of bloodstream infection.
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) state that laboratories must monitor, assess, and when indicated, correct problems identified in their preanalytic systems. Using the methods provided in this quality tool to calculate the BCC and single-set rates will help meet this standard and ensure optimal blood culture collection. In addition, this quality measure incorporates best practices on blood culture collection from the Clinical & Laboratory Standards Institute (CLSI) and the Infectious Disease Society of America (IDSA).
These best practices are already in place at many laboratories across the nation. Having best practices for quality measures:
- Improves the laboratory diagnosis of bacteremia.
- Significantly reduces incidence of BCC.
- Limits unnecessary antibiotic therapy.
CDC strongly encourages you to adopt these practices into your laboratory's standard operating procedures (SOPs), to integrate this measure into your quality management system, and to work with infection control and antibiotic stewardship programs to educate and train clinical staff on their use.
Follow CLIA Regulations
"Laboratory Requirements," Code of Federal Regulations, Title 42 (2023): Chapter IV, Part 493
The laboratory must establish and follow written policies and procedures for an ongoing mechanism to monitor, assess, and when indicated, correct problems identified in the preanalytic systems specified at §§ 493.1241 through 493.1242.