[Measures to reduce turnaround time (TAT): attempts for on blood cultures in Kyoto University Hospital].

Abstract

Because the detection of bacteremia is an important indication for subsequent treatment and prognosis, blood culture-positive results should be reported as soon as possible. Here, we present our attempts to promptly report the results of blood culture-positive samples and successive support systems for medical examinations. The BacT/ALERT system is used for culturing blood in our hospital. If a positive blood culture is obtained, medical technologists at the microbiological laboratory of our university hospital immediately contact the corresponding ward regarding the results of Gram staining and simultaneously inform the infectious disease physicians at the Department of Infection Control and Prevention. By using the positive blood cultures obtained from January 2003 to December 2004 (the period during which only day shifts on weekdays was supported), we determined the time required from blood specimen collection to obtaining positive samples from the culture system. When the samples were inserted into the system on the day following blood collection or later, the average time required was 48 hours. On the other hand, when the samples were inserted into the system on the day of blood collection, the average time required was 33 hours. After consideration of the importance of blood cultures, the examination system at the microbiological laboratory was changed to support day shifts every day in May 2008. The time taken from blood specimen collection for blood cultures to obtaining positive samples from the system was 40 hours on an average when day shifts were supported only on weekdays (during the above mentioned period), whereas the average time required was 31 hours when day shifts were supported every day (from May to June 2008). Since January 2002, the Department of Infection Control and Prevention have supported medical examinations for infectious diseases, including blood culture-positive cases. Compared between before and after the establishment of the support system (in 2001 and 2007), the 30-day mortality rates from bloodstream infections with Staphylococcus aureus and Candida spp. have improved from 30% to 17% and 56% to 23%, respectively. As indicated in our results, it is important to immediately deliver blood culture samples to the laboratory, start blood cultures (insert into the system), promptly report the results of Gram staining after the positive samples are obtained, and administer suitable antibiotic treatment.