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Use of sterile gloves reduces blood culture contamination

Clinical Question:
Does the use of sterile gloves during venipuncture for blood culture collection reduce the rate of culture contamination?

Bottom Line:
Routine sterile gloving during venipuncture for blood culture collection decreases the rate of culture contamination by half. Future studies should focus on a cost analysis of this protocol. (LOE = 1b)

Reference:
Kim N, Kim M, Lee S, et al. Effect of routine sterile gloving on contamination rates in blood culture. Ann Intern Med 2011;154(3):145-151.  [PMID:21282693]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Self-funded or unfunded

Allocation:
Concealed

Setting:
Inpatient (any location)

Synopsis:
In this single-center study, investigators randomized 64 medical interns, using concealed allocation, to routine sterile gloving for 2 weeks followed by optional sterile gloving for 2 weeks (and vice versa) during venipuncture for blood culture collection. During routine gloving, interns wore sterile gloves before every venipuncture. During optional gloving, interns wore sterile gloves only if needed. All interns were educated on the protocol for blood culture collection at the start of the study, as well as at crossover time. The study was carried out in general medicine wards, hematology wards, and an intensive care unit. Pediatric units and the emergency department were not included. Isolates from single positive blood cultures (ie, only 1 of 2 or more sets positive) were classified by 3 infectious disease specialists, masked to intern assignment, as likely contaminant, possible contaminant, or true pathogen. Over the course of 6 months, 5265 blood cultures were drawn during routine sterile gloving and 5255 during optional sterile gloving. Approximately two thirds in each group were drawn on a general medicine ward. For those interns who reported actual gloving methods, adherence to sterile gloves during the routine gloving period was more than 90% while use of sterile gloves during the optional period was only 7%. The baseline rate of contamination was unexpectedly low in this hospital at 0.9%, compared with a rate of 3% to 9% in other trials. For cultures classified as likely contaminants, the use of routine sterile gloving reduced the contamination rate from 0.9% to 0.5% (odds ratio = 0.51; 95% CI, 0.31-0.83; P = .007). In other words, to decrease the contamination rate by half, you would have to draw 2 sets of blood cultures from 125 patients to prevent 1 contaminated culture.

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