Reducing Blood Culture Contamination in the Emergency Department Using PIVO: A Quality Improvement Project

BACKGROUND: Blood culture contamination contributes to diagnostic delays, unnecessary antimicrobial therapy, increased length of stay, and excess health care costs. The emergency department in which this quality improvement project was implemented maintained a baseline contamination rate of 10.5%, exceeding the recommended benchmark of ≤3%. High-acuity emergency department workflows, characterized by rapid diagnostics, frequent intravenous manipulation, and workflow variability, further increase contamination risk. The PIVO device draws blood through a peripheral intravenous catheter by advancing a flexible cannula past the catheter tip and into the vein, bypassing the hub and insertion site where contamination commonly occurs. METHODS: This quality improvement project introduced PIVO into a level 1 trauma center emergency department with approximately 100 beds. Twenty registered nurses were trained and validated in PIVO use. Implementation strategies included staff training, supply optimization, and real-time tracking using bedside labeling and patient number identifiers. All blood cultures collected from November 3 to 30 were included. Contamination rates were compared between PIVO-obtained and standard cultures using a 2-proportion z-test. INTERVENTIONS: PIVO was integrated into routine blood culture workflows. Trained nurses performed PIVO-assisted draws, supported by supply caddies placed in each ED zone. Nontrained nurses could request assistance via overhead calls. Aside from the optional use of PIVO, standard workflows remained unchanged. RESULTS: Among 144 PIVO-obtained cultures, 4 were contaminated (2.6%). In contrast, 36 of 439 non-PIVO cultures (8.2%) were contaminated. The reduction associated with PIVO was statistically significant (P = .02). CONCLUSIONS: PIVO significantly reduced blood culture contamination and demonstrated strong feasibility in a high-acuity emergency department. Although many nurses reported positive experiences, some preferred traditional venipuncture during time-sensitive situations owing to slower blood return with PIVO. These workflow considerations highlight the importance of aligning implementation strategies with emergency department operational demands.