...annoying little BCx pet peeve...

[80sNurse]

anyone else out there have a policy requiring blood culture bottles be wiped off on the tops with alcohol wipes before use? and of course I'm talking about brand new, just opened bottles.

our hosp policy requires this, and I think it's an unneccessary step that adds manipulation to an already sterile area. amer college of path book I have from a few years ago doesn't call for this step at all.

just a little pet peeve I have to do (or feel really guilty about NOT doing!!) every day of my job :) !

If you're comfortable telling me where you work, that would help too. many thanks!

[CHRISTOPHERSDAD]

manufactures are no longer guarantying the sterility of the collection bottles just as they no longer guarantee it for injection meds even when the cap is first removed.

[ckh23, BSN, RN]

The tops may not be sterile.

[morte, LPN, LVN]

any bottle/vial that the covering can be "flipped" off, allows air underneath...there fore is not sterile.

[Nurse1966]

Yep, what they said...you wouldn't want to treat your patients for false positive cultures based on the normal flora of the people making the culture bottles. I've seen it happen, to a patient with already compromised kidneys, the antibiotics just killed a few more nephrons.

[simboka]

I just did the online inservice on this last night, and they mentioned wiping the tops with alcohol. I'd never heard this before, and wasn't in the process of doing this with BCx or IV meds, but I guess I'll have to start. PITA but if it's true about not guaranteeing the sterility of the stopper, then there's no other choice, right?

[morte, LPN, LVN]

I knew this 25 years ago, what happened to education?

[Flo., BSN, RN]

I graduated a few years ago and was taught this in school. It grosses me out to see nurses not wipe iv med bottles.

[EDrunnerRN]

It is also required where I work to swipe the top of each bottle with an alcohol pad. I ALWAYS do this step because I have received many phone calls from lab with "out of range" blood cultures, which includes one abnormal blood culture, most likely caused by normal flora that contaminated the culture. If only one bottle is contaminated it is thrown out as an outlier.

[shieldanvil81]

Alcohol? Where I work (an ER in Texas) I was taught to use chloraprep instead of alcohol swabs for sites where you're going to obtain a blood culture. Seems like you'd want to use the same precautions on the bottles.

[murphyle, BSN, RN]

Echoing what others have said: you don't know where that bottle top has been or how long it's been sitting OTA in the box or cart. Invariably when our culture contam rate starts creeping up, it's one of two things: people are using poor draw technique (inadequate prep, bare-hand manipulation of the site, etc) or not prepping the bottles.

We scrub the bottle tops with Betadine for 30 seconds, wipe with alcohol and then put a clean alcohol swab over the top of the bottle to protect it while you're setting up for the draw. When you're ready to fill the bottle, you take the swab off and inject. All our IV sites get Chloraprep, culture sites get a 1-minute scrub with it (except babies - 1 min with Betadine and then alcohol wipe).

Also, I'm curious: what is the "acceptable" contamination rate in your facilities? We start getting nasty-grams from management when we hit about 1% or so - they like it to be 0.5% or less.

[psu_213, BSN, RN]

Alcohol? Where I work (an ER in Texas) I was taught to use chloraprep instead of alcohol swabs for sites where you're going to obtain a blood culture. Seems like you'd want to use the same precautions on the bottles.

I was thinking the same thing (re: wiping the bottle tops with alcohol vs. chloraprep). Anyone know the reasoning?