Quality improvement project to improve blood culture volumes in haematology patients.

Abstract

Sepsis resulting from bloodstream infection is a medical emergency, especially in immunocompromised haematology patients. Identification of causative pathogens through blood cultures is crucial for delivering effective antibiotics promptly.Adequate blood culture volumes (BCV) are crucial for detecting bloodstream infections. Guidelines recommend 8-10 mL per blood culture bottle, yet achieving these volumes remains challenging. In our haematology wards, baseline mean BCV was suboptimal at 4.5 mL. This quality improvement project aimed to optimise BCVs to recommended levels within 6 months at a Singapore tertiary hospital's Department of Haematology.We implemented a multistakeholder quality improvement across three haematology wards from January 2023 to January 2025. Three Plan-Do-Study-Act cycles were executed from July 2024: (1) staff education and stakeholder engagement, (2) equipment and process enhancement and (3) validation of BCV measurements through comparison of an automated BCV measurement system (BD EpiCenter BACTEC Microbiology Data Management System) against manual bottle weighing.Postintervention data demonstrated clear statistical signals of improvements in BCV through both EpiCenter automated system and manual bottle weighing. Manual validation in selected wards demonstrated achievement of target volumes. Importantly, this validation process revealed potential limitations of automated measurement systems in our specialised clinical setting. Overall, our results demonstrate that a well-coordinated, multidisciplinary approach combining staff education and engagement, improved equipment and BCV measurement process can successfully achieve recommended BCV in our complex haematology settings.