New information based on policy decisions locally, regionally, and nationally is often presented to staff by
nurse leaders. Identify a recent change at your current, or most recent, workplace that was policy based.
Discuss the policy and how the change supported positive patient outcomes.
Week 1: Connecting Workplace Issues with Policy
Blood culture contamination is a common problem in the emergency department (ED)
that leads to unnecessary patient morbidity and health care costs. False-positive results in blood
cultures are primarily due to contaminants. These false-positive cultures, at the microbiological
laboratory level, require significant additional resources for workup. Additionally, they result in
unnecessary antibiotic treatment and hospitalization days, causing needless harm to
patients. Various methods have been implemented in order to reduce blood culture contaminants
including the use of 2% Chlorhexidine Gluconate (CHG) Cloths.
In October 2017, the Emergency Services Institute had significantly higher baseline rates
of blood culture contamination from peripheral sticks than any other department. The entire
emergency department went through individual mandatory blood culture training with the
departments Clinical Nurse Specialist and Nurse Educator. Even after proper training the
Emergency Department still has the high blood culture contamination rates from peripheral
sticks. The quality improvement (QI) intervention to use CHG cloths for reducing blood culture
contamination in the ED was initiated. Numerous studies have shown that Chlorhexidine bathing
is effective in reducing levels of pathogens on the skin. A 2% CHG impregnated alcohol-free no-
rinse cloth used for presurgical skin preparation is associated with excellent rapid reductions of
bacterial counts (Edmiston, Bruden, Rucinski, Henen, Graham, & Lewis, 2013). A practice
change outlining the proper use of the CHG cloths and collection technique using required sterile
kits has been implemented. The patient’s entire arm should be wiped using the CHG for 30
seconds, then allowed to dry completely. Next, the insertion site is scrubbed with Chloraprep for
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