Authors: (including presenting author): :
Cheng KL (1), Ng PY (1), Lee KP (1), Cheung WS (2), Chang SL (2), Luk S (2), Leung WC (3), Lam PK (4), Chan WMM (5)
Affiliation: :
(1)Infection Control Team, Caritas Medical Centre
(2)Infection Control Team, Princess Margaret Hospital
(3)Infection Control Team, Yan Chai Hospital
(4)Information Technology Division, Kowloon West Cluster
(5)Central Nursing Division, Kowloon West Cluster
Keyword 1: :
Blood culture contamination
Keyword 2: :
blood culture collection
Keyword 3: :
aseptic technique
Keyword 4: :
quality improvement
Introduction: :
Blood culture contamination has significant impacts on patient care and clinical outcomes. It can lead to false diagnoses of bacteremia or sepsis, resulting in unnecessary antibiotic treatment and increased healthcare costs. In Kowloon West Cluster (KWC) hospitals, contaminated blood cultures contributed to up to 9% of cases during the root cause analysis of MRSA bacteremia in 2024. To address this, a cluster-wide quality improvement program was initiated.
Objectives: :
(i) To standardize the protocol on blood culture collection across KWC
(ii) To evaluate the technique of collectors with repeatedly contamination events
(iii) To provide phlebotomists with specific, timely feedback on contamination rates.
Methodology: :
The Program was structured around three main pillars: (i) Standardization of Protocol: A unified KWC blood culture collection protocol was established, emphasizing sterile glove use, aseptic technique, and proper skin antisepsis. Comprehensive training materials—including a demonstration video, photo-guide, and competency checklist—were developed. Over 500 collectors (doctors, nurses, and phlebotomists) were trained in Q3–Q4 2025. (ii) Evaluation of Collectors with Repeated Contamination: Any collector (doctor, nurse, or phlebotomist) with two contamination events within six months underwent a formal reassessment of their technique using a standardized checklist. From 2024 to 2025, 73 collectors were evaluated. Common lapses identified included inadequate skin antisepsis contact time (< 30 seconds), failure to allow complete air-drying, and insufficient disinfection of the blood culture bottle septa. (iii) Phlebotomist-Specific Contamination Report: To close the feedback loop, a personalized contamination report—modeled on a successful initiative from Yan Chai Hospital—was implemented with the assistance of KWC and Head Office IT. This report provides individual contamination rates alongside an anonymous team average, fostering peer benchmarking, self-reflection, and behavioral change. The system was launched in Q3 2025.
Result & Outcome: :
This multifaceted initiative resulted in a measurable reduction in blood culture contamination. The contamination rate decreased by 6.7% from the first half (Q1–Q2) to the second half (Q3–Q4) of 2025 in KWC. A sub-group analysis was performed for individual hospitals due to different implementation stages. Notably, the Evaluation of Collectors with Repeated Contamination began in Q1 2024 at Caritas Medical Centre (CMC). With the addition of the other two interventions in 2025, the number of contaminated blood cultures at CMC decreased from 25 in Q1 2024 to 10 in Q4 2025, representing a 68% reduction. We anticipate achieving greater reductions as the program is fully implemented across all KWC hospitals. This reduction enhances patient safety and diagnostic accuracy while curbing unnecessary treatments and associated costs. Through a systemic approach combining protocol standardization, targeted reassessment, and continuous feedback, the program has identified key drivers for sustained improvement and equipped healthcare professionals with the tools and knowledge to adhere to best practices.
