Beginning Tuesday, March 15, 2016, UIHC will implement two standard adult blood culture orders that mirror the pediatric blood culture orders currently in place.  These are:

1) Order panel O120710, "BLOOD CULTURE – ADULT, MULTIPLE SETS"
Key points:

• Venipuncture is always preferred over blood draws through catheters, though both sources remain available in this order.  If drawing through a catheter in order to diagnose catheter-related bloodstream infection, use the other new order panel instead.
• This order defaults to 3 sets (6 bottles) but allows 1 to 5 sets of cultures to be drawn with the same order panel.
• Additional quality assurance questions are included that will assist the microbiology department in interpreting positive and negative cultures and allow QA feedback to providers.  Answers will auto-fill for subsequent culture sets.

2) Order panel O116026, "BLOOD CULTURE PANEL – ADULT CATHETER ASSOCIATED"
Key points:

• This panel is a new order that allows formal diagnosis of catheter-related bloodstream infection.  Please refer to the instructions in the order as site of draw and equal bottle fill are critical factors for success.

Additional motivations for this change were:

Quality Improvement:

• Reducing contaminants: Unnecessary catheter draws result in a spurious increase in surveillance CLABSI rates and detection of colonizing bacteria.
• Improved diagnosis of bacteremia: Volume of blood is the single most important variable for recovery of pathogens and the new order specifies the current standard for diagnosis of bacteremia (3 sets, 6 bottles) while allowing for practice variability.
• Diagnosis of catheter-associated bacteremia: no formal method was previously available for adult patients at UIHC.

Standardization:

• There were previously approximately 145 ad-hoc smartgroups and smartsets in Epic.  These are now rebuilt on either the standard blood culture order, the catheter-associated bacteremia order, or a single blood culture order.

Updated Practice Standards:

• The old standard order specifying 4 sets as an "adequate collection" is retired as 3 sets are almost always adequate.
• The old standard orders labeled "suboptimal" have been retired as one or two sets may be appropriate in some situations.

Questions concerning this broadcast can be directed to Bradley Ford, MD, PhD, Medical Director of Microbiology; (ext. 6-2990, bradley-ford-1@uiowa.edu).