1. Zanotti, Jennifer A. MS, RN, CCRN, CEN, CNS

Article Content


Contamination of blood cultures is a common problem. False-positive blood culture results may lead to errors in clinical interpretation; administration of inappropriate antibiotics; increased length of hospital stays; and increased costs.



Blood culture contamination rates were exceedingly high in our ED, with rates averaging 7% despite extensive educational efforts for ED RNs led by the hospital's infection control and microbiology laboratory personnel. The new CNS for the ED was challenged by the nursing director to lead efforts to decrease blood culture contamination rates.


Description of Project

After assessing the problem, the CNS focused on 2 themes in this project: (1) creating an environment making it is easy for nurses to do the right thing; (2) Providing education focusing on the significance of the problem, the research, and how to translate that research into practice. The CNS developed blood culture contamination bags. The CNS with the help of hospital volunteers packaged together all blood culture bottles with tincture of iodine and 70% alcohol prep pads in the lab specimen bag. Also included in this bag was a copy of our campaign slogan "SO the skin's bugs can die[horizontal ellipsis]let your preps dry[horizontal ellipsis]1 minute!!" The RNs and nursing technicians therefore always had the right prep readily available along with a reminder regarding drying times. Education was provided to RNs and technicians by the CNS in the format of 10-minute educational roving sessions. The CNS was available to reinforce teaching during the times of lower census and acuity in the busy ED. The campaign slogan was also posted through the department.



The ED's blood culture contamination rates dropped to 3.4% and 3.3% in the 2 months following this effort. The CNS has celebrated the success with the ED and continues to lead efforts to further decrease our rates to less than 3%.


Implications for Practice

This project supports that by providing resources and evidencebased education, blood culture contamination rates can be decreased significantly. The themes the CNS utilized for this practice change can be translated into other practice changes. This project also supports the role of the CNS in improving patient outcomes.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.