Skin preparation for prevention of blood culture contamination in children

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Our study results suggest that a single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures for children in Japan” Yodoshi et al (2019).

Abstract:

BACKGROUND: In Japan, blood cultures for children are performed by pediatric residents, and povidone-iodine (PI) is the recommended solution for skin preparation. Since PI should be applied for 1.5-2 minutes before venipuncture, this may be suboptimal for skin preparation. In this study, we aimed to determine blood culture contamination rate after skin preparation with only 70% isopropyl alcohol (IPA) or IPA plus PI.

METHODS: We performed a retrospective study of patients obtained blood cultures. Patients aged 6 years or younger who were reviewed obtained blood culture in the emergency department or pediatric ward. Patients with indwelling central venous catheter were excluded. We evaluated the impact of changing the methods of skin preparation, comparing the traditional method using IPA plus PI between 2008 and 2010 (IPA+PI group) with the simplified method using only IPA between 2015 and 2017 (IPA group).

RESULTS: A total 5,365 blood culture samples were eligible for this study. Of these, 171 (3.2%) had an organism identified in blood culture. Among blood culture-positive samples, 68 (1.3%) were true positive and 103 (1.9%) were contaminated. Thirty-eight (1.6%) of 2,407 cultures in the IPA group were contaminations; whereas 65 (2.2%) of 2,958 cultures in the IPA+PI group were contaminations (OR, 0.72; 95%Cl, 0.48 -1.07) (p = 0.1). Coagulase-negative Staphylococcus grew significantly less in the IPA Group (1.7% vs 1.0%, p = 0.02).

CONCLUSIONS: Our study results suggest that a single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures for children in Japan.

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Reference:

Yodoshi, T., Ueda, S. and Goldman, R.D. (2019) Skin Preparation for Prevention of Peripheral Blood Culture Contamination in Children. Pediatrics International. June 6th. doi: 10.1111/ped.13906. .

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