Blood cultures processing after death: Best practice, cost-effective, or HAI reduction measure.

Background: Blood cultures (BC) are essential for the diagnosis of bloodstream infections (BSI). BSI can be inaccurately attributed due to BC contamination or bacterial translocation. Reporting BCs after patient death (PD) can be inaccurate and potentially increase BSI incidence.

Methods: The study was performed in two phases, a retrospective review of positive BCs that resulted after PD and a prospective phase of discontinuing BC after PD. A cost-benefit analysis was conducted of the program considering the cost of HAIs.

Results: Retrospectively, there were 4,868 positive BC (10%) and 407 (8%) were finalized after PD. The BCs that resulted after PD and were identified as HAI included 8 CLABSI (Central Line Associated Blood Stream Infections), 11 primary and 25 secondary BSIs. During the prospective phase, the infection preventionists reviewed 795 patients and identified 285 with pending BC at the time of PD. 90.5% of these cultures were cancelled, reducing the number of potential HAI events related to BCs after PD to seven.

Conclusions: HAI rates could be falsely increased as NHSN (National Healthcare Safety Network) definitions do not address positive BC after PD. Implementing a stewardship protocol to discontinue BCs after PD is appropriate clinical practice and likely cost beneficial.