Collection of Blood Cultures
Blood Cultures are taken to identify patients with bacteraemia. It is imperative that blood cultures are taken correctly to avoid contamination of the specimen from skin flora which may result in a positive blood culture that may not be clinically significant. There are many signs and symptoms in a patient which may suggest bacteraemia and clinical judgement is required, but the following indicators (which may be subtle in the very young, the elderly, those on steroids or immuno-compromised) should be taken into account when assessing a patient for signs of bacteraemia or sepsis:
•	Pyrexia >38°C
•	Focal signs of infection
•	Abnormal heart rate (raised), blood pressure (low or raised) or raised respiratory rate
•	Chills or rigors
•	Raised or very low white blood cell count
•	New or worsening confusion
Please note: signs of sepsis may be minimal or absent in the very young and the elderly.
Only take blood for culture when there is a clinical need to do so and not as routine
Blood cultures should be taken after identification of possible bacteraemia or sepsis and before the administration of antibiotics. If endocarditis/prosthetic infection suspected take a minimum of two sets of blood cultures.
All blood cultures should be documented in the patient’s medical notes. Documentation should include date, time, site (peripheral, central line, lumen, etc.), indication for blood culture and the name and bleep number of the person performing the procedure.

Preparation zone (clean utility room)

Blood cultures should be transported to the laboratory as soon as possible after collection. Blood Culture Collection Procedure (see appendix 7 in the Aseptic Technique Policy)
Step1: Gather and prepare all materials required before beginning the procedure
Equipment required for blood culture collection; 
•	Clean procedure tray with integrated sharps bin (disinfect procedure tray with chlorine wipes before use).
•	Disposable tourniquet.
•	Single use sterile safety blood collection device.
•	Blood culture bottles and other blood bottles, if required.
•	Clinell wipes, or equivalent (2% chlorhexidine in 70% isopropyl alcohol impregnated swab).
•	Non sterile Nitrile or Latex gloves.
•	Other PPE – Plastic Apron/Goggles/Mask (required if risk of blood splash).
•	Appropriate sterile dressing.
•	Alcohol hand rub.
•	Blood culture bottles. Ensure bottles are fully intact and within date. Label bottles with appropriate patient information or use hospital addressograph label.
- Adult – use both an aerobic (blue top) and an anaerobic (purple top) bottle.
- Child – use Paediatric (pink top) bottle.	

Patient zone	Step 2: Prepare bottles for inoculation
•	Put on apron and eye/face protection if required as per risk assessment.
•	Decontaminate hands with alcohol hand rub on visibly clean hands or soap and water and dry.
•	Remove the plastic ‘flip-caps’ from the blood culture bottle, avoid touching rubber septum. Disinfect the tops of culture bottles (septum) for 15 seconds with a 2% chlorhexidine in 70% isopropyl alcohol impregnated swab (Clinell or equivalent). Allow the bottle tops to dry in order to fully disinfect. Use a  fresh swab for each bottle. 	

Patient zone	Step 3: Prepare venepuncture site
•	Confirm patient’s identity.
•	Clean any visibly soiled patient’s skin with soap and water, then dry.
•	Apply a disposable tourniquet and palpate to identify vein.
•	Decontaminate hands with alcohol hand rub.
•	Apply clean nitrile/latex gloves (sterile gloves are not necessary).
•	Disinfect the skin for 30 seconds with a 2% chlorhexidine in 70% isopropyl alcohol impregnated swab 
(Clinell or equivalent) and allow to dry. Do not palpate the site again after disinfection to prevent contaminating puncture site.
•	If a culture is being collected from an arterial line or central venous catheter, disinfect the access port with a 2% chlorhexidine in 70% isopropyl alcohol impregnated swab (Clinell or equivalent) and allow to dry.	

Patient zone	Step 4: Sample collection using a safety blood collection device
•	Peripheral blood cultures must be taken from a fresh puncture site
•	Insert single use safety device needle into vein. Do not palpate the site again after disinfection.
•	Collect sample into decontaminated bottles and release tourniquet. (Recommended volumes: 8ml -10ml for each adult bottle, 1ml - 3 ml for paediatric. Use of lower or higher volumes may adversely affect recovery and/or detection.) 
•	Do not contaminate the outside of the bottle. Inoculate anaerobic culture first.
•	If blood is being collected for other tests, always inoculate the blood culture bottles first.
•	Discard safety device into the sharps container immediately after use.
•	Cover the puncture site with an appropriate sterile dressing.	

Decontamination zone	Step 5: Decontamination
•	Dispose of blood stained items into healthcare risk waste bag (yellow bag) and all other waste into non risk waste bag. Ensure any blood contamination on the bottles is removed using a chlorine wipe.
•	Remove gloves and decontaminate hands.
•	Decontaminate tray with detergent wipe if visibly clean or a chlorine wipe if blood stained (risk assess need for PPE).
•	Remove PPE, if worn, and decontaminate hands.	

Labelling & Recording	Step 6: Sample management
•	Ensure the bottles are labelled with appropriate patient information or use of hospital addressograph label. Ensure that barcodes on the bottles are not covered by additional labels.
•	Do NOT cover or remove peel-off barcode labels. These are vital for Laboratory use only.
•	Complete microbiology request form giving full patient demographic details, clinical details, current antibiotics, date and time of specimen. State on bottles and form if blood is from a peripheral vein, an arterial line or a central line.
•	Place blood culture bottles in a sealed plastic specimen bag with the request form in the pouch.
•	Record the procedure with indication for blood culture collection, date and time, site of venepuncture and any complications in the patient’s medical record along with name and bleep number of person who performed procedure.	
Reference: Health Service Executive South East Laboratory. Recommendations for blood culture collection January 2017; Adapted from Taking blood cultures, A summary of best practice. NHS 2007