I certainly became aware of false positives when I was a fellow going through training, recognizing how every time we were distracted with a false positive, it took away from patients who were truly sick. If there's a false positive blood culture, that means the patient is subject to potentially unnecessary antibiotic therapy, additional testing that may be unnecessary to figure out where the infection's coming from, rather than focusing on why the patient's truly sick and trying to get them better and out the door. When I was a staff nurse in the emergency department, I really had no awareness of blood culture issues. We drew them and we went on with our day. It was another task that we checked off. It wasn't until I became an educator that I became aware that, oh, this is a big issue with big consequences. We never realized that false positives were driving poor patient flow. They're driving costs up. It's almost like false positives are just this silent vine that just takes over, but nobody really sees it because we're focused on other things, and it's a huge, huge part of what we have to do every day to lower costs and to lower our length of stay. We realized that we are potentially treating patients who don't even have a real infection. We're exposing them to unnecessary antibiotics, increased length of stay, and all the complications that go along with that, and as our individual organizations have an increasing focus on antimicrobial stewardship, and we realize that there are not insignificant quantities of antibiotics used to treat infections that aren't actually infections and they're false positives. Contamination can take a treatment plan in a completely different direction than what the patient actually needs, and it disguises a lot of the things that we should be paying attention to. Some of the dangers the patient faces when they're in the hospital for longer than they need to be include not only the C. diff, but they do include MRSA infections, skin breakdown, pulmonary embolus, DVTs, everything that you get from not kind of moving around and just being in a hospital. You know, just being in the environment itself puts you at risk. There are articles out there that have been written as early as 1990 about what it's costing your organization to continue to have these really high contamination rates. We're moving toward a world where hospital-acquired infections will not be covered under most insurance plans. And so if a patient develops C. diff disease during a hospital stay and it's a result of unnecessary antibiotic therapy, then any measures that are taken to treat the patient for that C. diff infection may not be covered by insurance, and so the hospital wouldn't get reimbursed for that care. The cost associated with some of these contaminations and some of these extra length of stays really falls on the hospital itself for the most part. If it costs you more to take care of that patient, that's less reimbursement the hospital will get from that stay. The more complications, the less money that certain payers are providing to the hospital, kind of the pay performance measures. I think that if emergency nurses really understood all of the consequences, the compliance would not be an issue. When educating nurses, especially in the emergency department, they have to see the relevance. If we don't understand the why, we may take shortcuts that we shouldn't take. I think the key to the sustainability is accountability. Our lab has signs that they put up that say, my results are only as good as the specimen you send me. And we weren't sending them good specimens. We were sending them contaminated specimens, and so the results weren't good. If they understand why they need to do it a certain way and do it well, then they'll do it right. What really drives it home is you tell them why you need to do it this way. And I find that you get a lot more compliance that way. If you tell them why. The nurses always want to know the why. It's about making it part of your culture. It's a culture of safety and a culture of doing what's right for the patient. From a patient perspective, I guess I try to think about my mother, who's in her 70s, and what would this mean to her? Every false positive is a story. It's a person that we're affecting. Essentially, it comes down to, is the patient getting the quality care that they deserve and that they're seeking? And are we doing everything we can to make sure that they get that? And having those low contamination rates is one of those ways that we can get there.

false positive blood cultures

healthcare settings

antibiotic therapy

patient flow

hospital-acquired infections