Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings.

BACKGROUND AND OBJECTIVE: Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. METHODS: A sterile blood culture collection process was designed by analyzing current practice and identifying areas in which sterile technique could be introduced. To spread the new technique, a web-based educational model was developed and disseminated. Subsequently, all nursing staff members were expected to perform peripheral blood cultures by using the modified sterile technique. RESULTS: The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period (P < .0001), with yearly estimated savings of ~$250,000 in hospital charges. CONCLUSIONS: Subsequent to our intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter.

[A case of primary herpetic eye disease]. / Un cas de primo-infection herpétique oculaire.

Herpetic eye disease is very common. However, primary infections are most frequently asymptomatic. We report herein a case of a 15-year-old male whose diagnosis of primary herpetic infection was delayed and who initially had unsuitable treatment that aggravated the symptoms. This case highlights the importance of early diagnosis of primary herpetic infection, which allows an adapted therapeutic care.

Short-term low-protein intake does not increase serum parathyroid hormone concentration in humans.

We investigated whether inadequate dietary protein would result in increased serum parathyroid hormone (PTH) concentration, consistent with secondary hyperparathyroidism. Data from 2 controlled feeding studies were utilized. In study 1, 26 healthy women (15 young, 21-46 y, and 11 elderly, 70-81 y) consumed for 12 d each in separate trials 3 levels of protein, 1.00, 0.75, and 0.50 g protein/(kg. d). Blood was drawn from fasting subjects on d 12 of each trial. In study 2, 24 persons (54-80 y) were fed diets with either 1.20 g protein/(kg. d) for 2 wk (HPro, n = 11, 6 men, 5 women) or 1.2 g protein/(kg. d) for 1 wk and then 0.50 g protein/(kg. d) for a 2nd week (IPro, n = 13, 6 men, 7 women). Blood was obtained from fasting subjects after wk 1 and 2. Consistent with altered protein metabolism, urinary total nitrogen excretion and blood urea nitrogen fell progressively with decreasing protein intake in study 1; in study 2, the values decreased from wk 1 to 2 in the IPro group only. Serum intact PTH concentrations did not differ among the 3 protein intakes in study 1, or between the HPro and IPro groups in study 2. These findings do not support the hypothesis that the short-term ingestion of inadequate dietary protein increases serum PTH concentration.