Sepsis care pathway: BD’s solutions to improve blood culture collection

On 21 and 22 June we invited a range of healthcare professionals, sepsis nurses and phlebotomists to attend our second ‘Saving Time Changes Lives’ event which took place at our BD UK headquarters in Winnersh and off-site in Manchester. The events highlighted the importance of a quality bloodstream infection pathway with a comprehensive approach to sepsis patient care. It is in the context of this event that we want to highlight National Pathology Week and this year’s theme ‘Pathologists and Patients’. It is crucial that we raise the standard of care throughout our healthcare systems – at BD, we recognise the importance of a patient-centric, end-to-end diagnostic pathway.

Sepsis is a potentially fatal immune system reaction to an infection in the body that results in tissue and organ damage. An efficient and reliable diagnostic pathway is crucial for the management of antimicrobial resistance (AMR) and sepsis. The misuse of antibiotics globally has made the problem of AMR a major threat to public health. Serious infections, complications, longer hospital admissions, and an increase in mortality are associated with growing antibiotic resistance, and the treatment of sepsis faces significant challenges because of AMR.

Administering effective treatment choices requires the early diagnosis of bloodstream infections and sepsis; and blood cultures play a key role in identifying the pathogen(s) responsible for a patient’s infection. As part of the NHS long term plan, and under the guidance that is being mandated by NHS England, every trust must take action to spot and treat sepsis, which costs 37,000 lives a year.

The proper use of blood cultures is crucial to the management of the hospitalized patient. NHS England guidelines state that two sets of blood cultures should be collected (collecting between 20-30ml per set) but a recent study showed that almost 90% of hospitals do not check how much blood has been collected to be submitted for culture – leading to increased risk of inaccurate results and the need for re-testing – ultimately reducing the efficiency of the pathway. Andrew Haldenby, Chair Director and Co-Founder of Aiming for Health Success, believes solutions need to be made on a local level, “local ownership of issues at trust level is the way forward”. Trusts should concentrate on enhancing every step of the blood culture pathway, from sample collection and laboratory analysis to reporting.

The end-to-end diagnostic pathway
To improve patient outcomes and minimise the impacts of AMR, the blood culture pathway must be streamlined to offer reliability and consistency across all hospitals and laboratories in the UK. With increased rates of diagnostics, studies have shown that 22.7% of sepsis-associated deaths were due to suboptimal care, often because of delays in antibiotics, of which 3.7% could have been preventable.

In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributed. Antimicrobials are the main treatment for sepsis, and with sepsis fatality rates increasing, antimicrobials lose their effectiveness. Recent data showcased that lower costs, fewer deaths, more accurate positive results from the analyser, reduced length of stay in hospitals and a reduction in costs associated with ICU and C. Difficile. Jane Freeman concluded that investing in improving the blood culture pathway “does not cost money and saves lives”, suggesting that we must make advancements today for our future.

From collecting blood samples to treatment, the entire sepsis diagnostic pathway must be performed accurately. The procedure for collecting blood for culture is essential since, if caution is not used, the result may suffer. It is therefore crucial to use aseptic techniques because failing to do so significantly increases the likelihood of getting contaminated samples. By mapping the blood culture process, it is possible to identify critical control points where delays may occur. In targeting these, there is great potential to improve turnaround times leading to more efficient patient care without incurring excess laboratory or other costs.

To ensure the pathway is operating as efficiently as possible, investigation and auditing is crucial. The patient should be at the heart of every choice, and the outcome for the patient depends on every action taken along this journey. Dr Jane Freeman, Clinical Scientist in Microbiology – Leeds Teaching Hospitals/NHS England, believes “if you make the investment needed within the blood culture pathway, you will not lose money and you will save lives”.

Importance of collaboration
The WHO describes a future of a post-antibiotic world and warns that not only will this eliminate the progress made in healthcare over the past 100 years, which have ensured longer life in most parts of the developed and developing worlds, but it may also result in simple infections becoming unmanageable and potentially fatal.

Through multidisciplinary working we can improve the end-to-end diagnostic pathway, to ensure:

• Earlier identification of positive blood cultures, permitting more rapid availability of pathogen identification and sensitivities
• Improved antimicrobial management involves optimising effective antimicrobial therapies
• Cost savings and reduced pressure on clinical staff
• Improved clinical outcomes, including contributing to the national drive on sepsis, sepsis six, and reduced length of hospital stay

When collaborating, it is essential to engage all relevant stakeholders at an early stage. Ensure good quality, meaningful data and desired outcomes are defined and embed any relevant changes into standard operating procedures to ensure they are sustainable. “The key is collaboration; we can’t make effective change if we work individually”, Claire Burnett Lead Sepsis Nurse – Royal Berkshire Hospital.

To support each stage of the blood culture pathway, integrated diagnostic solutions can promote adherence to national guidelines, address the growing threat of AMR, and enhance patient outcomes. BD offer a range of products, services and solutions to support the optimisation of the blood culture pathway and the implementation of improvements by NHS Trusts’.

Closing
Bloodstream infection and sepsis are complex problems that require a united multisectoral approach. Early detection is essential to reducing the risk of AMR and improving patient outcomes. Collaboration will enable us to increase the rate of detection, improve the swift implementation of appropriate antimicrobial therapy, and positively impact patient outcomes. We must optimize how we manage patients across the entire sepsis care pathway, identifying areas for improvement and sustain best practices.

BD’s solutions may contribute to improving blood culture collection, pathogen detection and reducing time to antimicrobial therapy, with the ultimate goal of improving patient outcome.
MB Bureau