AMCLI 2024 – Monitoring in the pre-analytical phase of blood cultures: context and rationale of the BD DREAM BSI Project
The AMCLI (Association of Italian Clinical Microbiologists) National Congress 2024, now in its 51st edition, was held 8-11th March at the Rimini Palacongressi.
BD, as a corporate provider of not only products but also services, hosted the workshop under the name “Measuring to improve blood culture pre-analytics” moderated by Dr. Pierangelo Clerici, within which we discussed the importance of measuring the performance of the pre-analytical phase of blood cultures and how it impacts the management process of septic patients, presenting our innovative solution: the BD DREAM BSI project.
The BD DREAM BSI (Blood Stream Infections) project aims to support hospitals in fighting circulatory infections through the availability of a service that provides continuous KPI (Key Performance Indicator) monitoring throughout the diagnostic pathway involving the patient with suspected sepsis. The service provides useful information to improve the pre-analytical phase, as well as the suitability of blood culture requests and understanding of local epidemiology, with a special focus on Multi Drug Resistant Organisms (MDROs).
The diagnostic pathway of circulatory infections is complex and articulated, and Prof. Fabio Arena from Foggia Hospital emphasised how necessary it is to embark on a process of continuous improvement based on monitoring what are known as the key indicators.
It is important to consider indicators, particularly in the pre-analytical stage of blood cultures, which is the one most prone to variability and error. However, collecting the data needed to calculate KPIs is complex and out of the reach of most microbiology laboratories. Therefore, specific and robust tools are needed to quickly circulate and process data in order to provide practitioners with key information on how to act on the pathway with corrective actions.
BD DREAM BSI, as reiterated by the Professor, is a service that can be useful in improving hospital management of patients with suspected sepsis through continuously monitoring these KPIs within the entire diagnostic pathway. Based on the data collected, it is finally possible to evaluate the implementation of each specific corrective action with the experts. Ultimately, KPIs are monitored at scheduled intervals to check whether the processes undertaken are the right ones, with the aim of improving the sepsis management pathway as much as possible. Developing and maintaining a culture of safety serves to protect not only patients but also health care practitioners, reducing risks from inappropriate practices and making the entire system more efficient.
In her speech, Prof. Antonella Mencacci stressed the importance of “measuring oneself” as it represents a chance to improve and get a fel for the local context. The professor then projected data from her real-life experience at Perugia Hospital, where, after measuring the performance of the pre-analytical phase of blood cultures, a number of corrective actions were implemented, e.g., training events and audits that led to major improvements in the process and the new KPI measurement. More specifically, the contamination rate of blood cultures performed with blood drawn from peripheral veins (PVs) was found to have decreased dramatically due to the improvement in the quality of sample collection achieved as a result of corrective actions.
Thus, it can be understood how, in order to manage the diagnosis of infection, an approach based on the risk stratification of sepsis and septic shock is needed, as well as the use of new diagnostic management actions (so-called diagnostic stewardship) and treatments. The goal of diagnostic stewardship is, in fact, to choose the right diagnostic pathway for each patient, generating clinically relevant and accurate results as quickly as possible in order to have the most positive impact on the patient’s outcome.
In this regard, Prof. Giampaola Monti from Niguarda Hospital in Milan, Italy, has shown through published studies which KPIs should be measured and what impact they have on patient outcomes. The sample volume, for example, is crucial when it comes to detecting pathogens in the appropriate time; in fact, inadequate volumes lead to longer detection times and the possibility of diagnostic error. The use of a single set of blood cultures also leads to 10 to 40% of bacteremia diagnoses being missed (Lee A. J Clin Microbiol 2007); lastly, contaminations have been shown to cause increased hospitalisation rates, unsuitable therapies, and costs.
At AMCLI, we have laid the foundation to advance sepsis patient management and position ourselves as a trusted partner for laboratories and hospitals in optimising the management of blood cultures and sepsis patients. Thank you for participating and if you would like to be contacted by a BD consultant to talk about BD DREAM BSI, please fill out the form below.
BD-132162
