Reducing blood culture contamination: an environmental imperative
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Abstract Blood culture (BC) investigation remains the gold standard for diagnosis of bloodstream infections. However, BC contamination can have clinical implications for the patient, cost implications for service providers and less well documented, environmental impacts. Efforts to reduce BC contamination are a longstanding theme in quality improvement initiatives in emergency departments and hospitals, prompted by the hospital costs, healthcare inefficiencies and antimicrobial stewardship efforts [1,2]. The WHO global analysis of health care waste in the context of COVID-19, has reported that tens of thousands of tonnes of extra medical waste was produced from the response to the COVID-19 pandemic, basing its estimates on the quantity of personal protective equipment (PPE) [3]. Additionally, recent literature has also shown increased BC contamination rates during the COVID-19 pandemic. Our study reviews the trend of BC contamination during the COVID-19 pandemic in our institution’s Emergency Department. We further discuss some of the potential implications of BC contamination, including potential environmental, economic and efficiency implications.
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
In this manuscript, the authors review blood culture contamination trends during the pandemic and explore the potential environmental, economic, and efficiency implications of such contamination. The discussion and conclusions are well-supported by the data. Methodological rigor was maintained throughout the research process. Below are some suggestions for further improving the manuscript. 1) Remove citations from the Abstract and explicitly state that the work is a review. 2) The information in Figure 1 is displayed in gray. Please change it to black. 3) If possible, I recommend presenting some of the data in table format. 4) Considering the number of words in the manuscript, the suggestion is to publish it as a mini-review.
Please rate the manuscript for methodological rigour
Good
Comments to Author
In this manuscript, the authors review blood culture contamination trends during the pandemic and explore the potential environmental, economic, and efficiency implications of such contamination. The discussion and conclusions are well-supported by the data. Methodological rigor was maintained throughout the research process. Below are some suggestions for further improving the manuscript. 1) Remove citations from the Abstract and explicitly state that the work is a review. 2) The information in Figure 1 is displayed in gray. Please change it to black. 3) If possible, I recommend presenting some of the data in table format. 4) Considering the number of words in the manuscript, the suggestion is to publish it as a mini-review.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Write exact date or at least month in the introduction section "Our study has explored the retrieval rate of BC and the trend of BC contamination in the Emergency Department (ED) in an Irish Tertiary Referral Hospital over a 4.5 year period from January 2018 to June 2022." Discuss the severity of BC contamination in the introduction section. Add references in methodology. Rephrase this statement in methodology section to make complete sense "Further data was retrieved on the total number of BC sets processed by the South East Regional Microbiology Laboratory at UHW, which provides a hub and spoke service to three other model 3 hospitals, in order to estimate the downstream regional impact of BC contamination." use third person pronouns. Use updated references. {reference 7}
Please rate …
Comments to Author
Write exact date or at least month in the introduction section "Our study has explored the retrieval rate of BC and the trend of BC contamination in the Emergency Department (ED) in an Irish Tertiary Referral Hospital over a 4.5 year period from January 2018 to June 2022." Discuss the severity of BC contamination in the introduction section. Add references in methodology. Rephrase this statement in methodology section to make complete sense "Further data was retrieved on the total number of BC sets processed by the South East Regional Microbiology Laboratory at UHW, which provides a hub and spoke service to three other model 3 hospitals, in order to estimate the downstream regional impact of BC contamination." use third person pronouns. Use updated references. {reference 7}
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
This manuscript explores blood culture contamination rates in the Emergency Department of an Irish hospital, with a focus on changes during the COVID-19 pandemic. The study highlights fluctuations in contamination rates across pandemic waves and discusses the potential resource, economic, and environmental impacts of these contaminations. While the analysis is insightful, it lacks detailed quantitative analysis on the influence of PPE usage and staffing changes. Decision: Minor revisions. 1.The reduction in contamination rates in 2019 is attributed to hospital-wide guidelines. However, the analysis lacks clear quantified evidence linking the drop in contamination directly to the intervention. Were there any other operational changes during this period that could have influenced the results? 2.The …
Comments to Author
This manuscript explores blood culture contamination rates in the Emergency Department of an Irish hospital, with a focus on changes during the COVID-19 pandemic. The study highlights fluctuations in contamination rates across pandemic waves and discusses the potential resource, economic, and environmental impacts of these contaminations. While the analysis is insightful, it lacks detailed quantitative analysis on the influence of PPE usage and staffing changes. Decision: Minor revisions. 1.The reduction in contamination rates in 2019 is attributed to hospital-wide guidelines. However, the analysis lacks clear quantified evidence linking the drop in contamination directly to the intervention. Were there any other operational changes during this period that could have influenced the results? 2.The results indicate that fewer BC sets were retrieved during the lockdown, but contamination rates still remained significant. This seems counterintuitive, as fewer samples might suggest better care in collection. Can you explain why contamination rates did not decrease alongside the reduction in overall BC retrieval? 3.While the discussion covers pandemic-related contamination fluctuations, the lack of a detailed comparison to pre-pandemic contamination trends makes it hard to assess whether the pandemic significantly altered the contamination landscape. Including a more thorough analysis of pre-pandemic contamination rates would strengthen the conclusions.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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