6th Edition of World Nursing Science Conference 2026

Abstract

Blood culture contamination contributes to diagnostic error, unnecessary antibiotic exposure, and increased healthcare costs. At the project site, a high volume suburban Colorado emergency department, contamination rates exceeded the national benchmark of 3%, and no standardized specimen diversion process was in place. This quality improvement project evaluated whether implementing the Emergency Nurses Association’s Clinical Practice Guideline: Prevention of Blood Culture Contamination, specifically initial specimen diversion, would reduce contamination among adult ED patients.
Over an eight week implementation period, staff were trained in standardized diversion technique, and contamination outcomes were compared with an eight week pre implementation phase. Guided by Duffy and Hoskins’ Quality Caring Model and Lewin’s Change Management Theory, the project analyzed 2,994 blood cultures (n = 1,482 comparative; n = 1,512 implementation) extracted from the electronic health record. A chi square test showed no statistically significant difference in contamination rates following implementation, χ²(1, N = 2,994) = 1.969, p = .161. However, clinically meaningful improvements were observed: the number of nurses with zero contamination events increased by 20% after implementation, and contamination was concentrated among a small subset of collectors, highlighting opportunities for targeted competency reinforcement.
Although statistical significance was not achieved, the project demonstrated the value of structured education, standardized techniques, and real-time performance monitoring in supporting contamination-prevention practices. Findings underscore the need for sustained training, focused coaching for newer staff, and extended implementation periods to optimize adherence and achieve measurable reductions in contamination. This work contributes to diagnostic stewardship efforts and informs future strategies to enhance patient safety and quality of care in emergency settings.