Phlebotomists, and why we like them, part 2

Mike’s post points to the cost savings that may be achieved through reduced blood culture contamination rates, a strong argument for phlebotomy teams.   The article Mike cited focused on emergency departments, but phlebotomists offer even more benefits in the hospital, including improved bloodstream infection surveillance.  Since coagulase-negative staphylococci (CoNS) are both the most common cause of central line associated bloodstream infection (CLABSI) and the most common blood culture contaminant, high contamination rates lead to a lot of misclassification.   

The problem of contaminants being classified as CLABSIs has been reduced by the change in NHSN surveillance definition, which now requires 2 or more cultures positive for common skin contaminants (like CoNS) to define a CLABSI.  The most likely form of misclassification now is probably failure to identify true CLABSIs due to skin contaminants—either because 1 positive out of 2 cultures still has a predictive value of 20% for CLABSI, or because only one culture was obtained (often through a central line).  Incorrect blood culture practices like this are much more likely when trained phlebotomists are unavailable, leaving blood cultures to be obtained by busy nurses, residents or medical students.

So let’s hope that tighter hospital budgets don’t result in short-sighted decisions to cut back on phlebotomy services—the costs of increased blood culture contamination rates and substandard blood culture collection practices are likely to far outweigh any savings……