Nak-Hyun Kim, MD; Moonsuk Kim, MD; Shinwon Lee, MD; Na Ra Yun, MD; Kye-Hyung Kim, MD; Sang Won Park, MD, PhD; Hong Bin Kim, MD, PhD; Nam-Joong Kim, MD, PhD; Eui-Chong Kim, MD, PhD; Wan Beom Park, MD, PhD; Myoung-don Oh, MD, PhD
Blood culture contamination leads to inappropriate or unnecessary antibiotic use. However, practical guidelines are inconsistent about the routine use of sterile gloving in collection of blood for culture.
To determine whether the routine use of sterile gloving before venipuncture reduces blood culture contamination rates.
Cluster randomized, assessor-blinded, crossover trial (ClinicalTrials.gov registration number: NCT00973063).
Single-center trial involving medical wards and the intensive care unit.
64 interns in charge of collection of blood for culture were randomly assigned to routine-to-optional or optional-to-routine sterile gloving groups for 1854 adult patients who needed blood cultures.
During routine sterile gloving, the interns wore sterile gloves every time before venipuncture, but during optional sterile gloving, sterile gloves were worn only if needed.
Isolates from single positive blood cultures were classified as likely contaminant, possible contaminant, or true pathogen. Contamination rates were compared by using generalized mixed models.
A total of 10 520 blood cultures were analyzed: 5265 from the routine sterile gloving period and 5255 from the optional sterile gloving period. When possible contaminants were included, the contamination rate was 0.6% in routine sterile gloving and 1.1% in optional sterile gloving (adjusted odds ratio, 0.57 [95% CI, 0.37 to 0.87]; P = 0.009). When only likely contaminants were included, the contamination rate was 0.5% in routine sterile gloving and 0.9% in optional sterile gloving (adjusted odds ratio, 0.51 [CI, 0.31 to 0.83]; P = 0.007).
Blood cultures from the emergency department, surgical wards, and pediatric wards were not assessed.
Routine sterile gloving before venipuncture may reduce blood culture contamination.
False-positive blood cultures are common and lead to additional medical testing, unnecessary antibiotic use, and increased health care costs.
In a randomized, controlled trial, use of sterile gloves while drawing blood for culture reduced the contamination rate by almost one half compared with usual practice.
Only interns drew blood for culture, and they were not blinded to the type of glove used. The study was done in only 1 institution, and blood for culture was obtained only on general medical floors.
Routine sterile gloving may be a useful strategy to reduce blood culture contamination rates.
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Shelley M. Gordon
Infectious Diseases Associates Medical Group, Inc., San Francisco, CA
March 1, 2011
Compliance with hand-washing
To the Editor:
Kim et al. report a 50% reduction in the rate of sterile blood culture contamination due to routine use of sterile gloving (1). The one factor that they did not take into account was compliance with hand- washing. In a setting where hand-washing compliance is poor, the use of sterile gloves may provide a benefit; however, good hand-washing compliance may afford the same benefit with lower cost. Any attempt to validate this finding should take hand-washing compliance into account by direct observation.
1. Nak-Hyun Kim, Moonsuk Kim, Shinwon Lee, et al. Effect of Routine Sterile Gloving on Contamination Rates in Blood Culture. Ann Intern Med. 2011;154:145-151.
Wan Beom Park
Seoul National University College of Medicine
March 13, 2011
Re:Compliance with hand-washing
In Response: We appreciate the interesting comment that hand-washing compliance should be considered in our study, which compared the rates of blood culture contamination between clean (protective) and sterile gloving methods (1). In general, hand washing before donning non-sterile gloves is not routinely recommended (2), and a study demonstrated that volunteers did not contaminate the outside of their gloves significantly more often when they did not wash their hands before wearing gloves than when they washed their hands first (3). However, in order to exclude potential influence of hand-washing before donning clean or sterile gloves on the rates of blood culture contamination, we educated the interns to wash their hands before putting on clean or sterile gloves using an alcohol-based hand rub which was equipped on every single bed in our institution. The hand washing before donning gloves was equally emphasized in both clean and sterile gloving methods. We do not believe that our study was performed in a setting where hand- washing compliance was poor considering repeated education on hand hygiene, availability of hand rub at bedside and the low rate of blood culture contamination in our study, although we did not monitor the compliance of hand washing by direct observation. Herein, it is very unlikely that poor compliance with hand-washing exaggerated the effect of routine sterile gloving on reducing contamination rates of blood culture in our study.
1. Kim NH, Kim M, Lee S, Yun NR, Kim KH, Park SW, et al. Effect of routine sterile gloving on contamination rates in blood culture. A cluster randomized trial. Ann Intern Med. 2011;154:145-51.
2. World Health Organization. WHO guidelines in hand hygiene in health care. Geneva, Switzerland, WHO Press, World Health Organization. 2009:129.
3. Rossoff LJ, Borenstein M, Isenberg HD. Is hand washing really needed in an intensive care unit? Crit Care Med. 1995;23:1211-6.
Kim N, Kim M, Lee S, Yun NR, Kim K, Park SW, et al. Effect of Routine Sterile Gloving on Contamination Rates in Blood Culture: A Cluster Randomized Trial. Ann Intern Med. 2011;154:145-151. doi: 10.7326/0003-4819-154-3-201102010-00003
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Published: Ann Intern Med. 2011;154(3):145-151.
Hospital Medicine, Infectious Disease, Pulmonary/Critical Care.
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