增加採檢量提高血液培養陽性率

Introduction of Standard Operation Procedures for Increasing the Positive Rate of Blood Culture

「血液培養」是細菌性敗血症診斷的黃金標準，當有任何細菌感染的臨床症狀並懷疑為血液感染時，即建議執行血液培養，並採集足夠血量，期能培養出細菌，得到正確診斷。因此此篇研究的目的是先針對醫護人員進行教育訓練，並採用翼型安全採血套組，以期增加血液培養採檢量，對象為中部某醫學中心，利用不同病室單位護理人員採檢競賽評比方式，以達院內血液培養採檢品質提升，再由實驗室進行採檢量及陽性率分析。結果顯示血液培養採檢量由平均3.7mL增加至7.0mL（p=0.021），陽性率由10.8%提升至12.4%（r=0.698，p=0.012），陽性偵測時間由26小時下降為23小時，扣除汙染之陽性率由8.8%提升至9.9%，因此血量增加與扣除汙染後陽性率提升的相關係數r值為0.741，p值為0.006。由此顯見正確良好的血液檢體採集與足夠的血量可以提高血液培養陽性率，並縮短培養時間，對臨床診斷和治療上，有很大的助益。

For sepsis diagnosis, blood cultures remain the gold standard to confirm the infection. It is recommended that blood cultures with optimal blood volume should be obtained from patients suspected of having blood stream infections, to enhance recovery. The purpose of this study was to educate blood collectors on collecting adequate blood volume using safety needles. After the training program in a medical center located in central Taiwan, selected wards proceeded to perform blood volume collection. Results show that average blood volume increased from 3.65 mL to 7.0 mL (p = 0.0209), recovery rate increased from 10.8% to 12.4% (r = 0.698, p = 0.012), recovery rate excluding contamination increased from 8.8% to 9.9%, and the correlation coefficient between blood volume and recovery rate excluding contamination was 0.741 (p = 0.006). In addition, we observed faster time to positive blood culture from 26 hours to 23 hours. In conclusion, following best practices to collect optimal blood volume will contribute to the quality improvement of sepsis diagnosis.