PEDIATRIC BLOOD CULTURE GUIDE

DOCUMENT TYPE: GUIDELINE

Site Applicability This guideline applies to all healthcare providers, including physicians, providing care for pediatric patients for whom blood cultures are required at BC Children’s Hospital.

BC Women’s Hospital – Neonatal Program utilizes this guideline to refer blood culture collection volumes. Refer to NN.16.01 Blood Culture Collection Procedure for Neonatal Program.

Purpose This guideline is designed to provide guidance to healthcare providers in the appropriate collection of blood culture samples from children.

Background Blood cultures are among the most frequently submitted samples to the Microbiology laboratory and are used in the diagnosis and management of many potentially life threatening infections. They are generally collected in patients who require admission to hospital but may be collected from outpatients in certain circumstances (e.g. to investigate for possible infective endocarditis). Blood volume collected correlates closely with the likelihood of recovering the causative pathogen and also with a shorter time to detection.

Guideline Weight based recommendations for volumes collected and blood culture collection bottles to be used are shown for routine pediatric blood cultures (Table 1) and for anaerobic blood cultures (Table 2) below.

Table 1: Routine patients‡ Pediatric Blood Culture Order

Child’s weight (kg) Collect: Inoculate following bottles: <1 0.5-1 mL 0.5 – 1 mL to Peds Plus

1 to 1.9 1 mL 1 mL to Peds Plus

2 to 2.9 2 mL 2 mL to Peds Plus

3 to 3.9 3 mL 3 mL to Peds Plus

4-5.9 5 mL 5 mL to Aerobic

6 to 7.9 7 mL 7 mL to Aerobic

8 to 11.9 10 mL 10 mL to Aerobic

12 to 17.9 15 mL Divide equally into 2 Aerobic

18 to 29.9 20 mL Divide equally into 2 Aerobic

30 to 39.9 30 mL Divide equally into 3 Aerobic

10 mL to Aerobic #1 20 mL site 1 10 mL to Anaerobic #1 40 or greater 10 mL to Aerobic #2 20 mL site 2* 10 mL to Anaerobic #2

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DOCUMENT TYPE: GUIDELINE

Table2: Anaerobic† (including Oncology) Pediatric Blood Culture Order

Child’s weight (kg) Collect (ml): Inoculate the following bottles‡: <1 0.5 mL to Peds 0.75 – 1 mL 0.25 mL – 0.5 mL to Anaerobic Plus 1 to 1.9 1.5 mL 1 mL to Peds Plus 0.5 mL to Anaerobic

2 to 2.9 2 mL 1 mL to Peds Plus 1 mL to Anaerobic

3 to 3.9 1.5 mL to Peds 3 mL 1.5 mL to Anaerobic Plus 4-5.9 2.5 mL to Peds 5 mL 2.5 mL to Anaerobic Plus 6 to 7.9 3.5 mL to Peds 7 mL 3.5 mL to Anaerobic Plus 8 to 11.9 10 mL 5 mL to aerobic 5 mL to Anaerobic

12 to 17.9 15 mL 10 mL to Aerobic 5 mL to Anaerobic

18 to 29.9 20 mL 10 mL to Aerobic 10 mL to Anaerobic

20 mL divided into 30 to 39.9 30 mL 10 mL to Anaerobic 2 Aerobic 10 mL into Aerobic #1 20 mL site 1 10 mL to Anaerobic #1 40 or greater 10 mL to Aerobic #2 20 mL site 2* 10 mL to Anaerobic #2

† Indications for Anaerobic cultures include: • intraabdominal or pelvic infection, necrotizing enterocolitis in neonates • mouth/neck infection, including septic thrombophlebitis (e.g. Lemierre’s) • necrotizing soft tissue infection • infected bite wounds • immunosuppressed host • prolonged fever of unknown origin with negative aerobic cultures • Any patients >40 kg

‡ If patient has Central Venous Line (CVL), divide total aerobic volume by number of lumens and collect this volume from each lumen and place each in separate aerobic bottle(s). If the volume going into each aerobic bottle is < 5 mL Peds Plus bottles (pink top) should be used; if it is ≥ 5mL aerobic bottles (grey top) should be used.

* Site 2 can be from either a peripheral site or from another lumen of a CVL if the patient has multiple lumens.

“Discard” blood can be used from a CVL for blood culture unless there is an indwelling antibiotic therapy (i.e. “antibiotic lock” therapy). In this case, the discard volume should not be used for the blood culture.

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DOCUMENT TYPE: GUIDELINE

Fungal blood cultures are generally of little added benefit unless there is concern for certain endemic mycoses (e.g. Histoplasmosis) or Malassezia spp. infection. Routine aerobic blood culture bottles are adequate for recovery of yeasts such as Candida spp. If fungal-specific or mycobacterial cultures are required contact Medical Microbiologist on call.

Equipment for Central Venous Line Blood Culture Collection  Requisitions and computerized or addressograph labels for patient - note that each “site” requires its own requisition  Hospital grade surface disinfectant wipes  Chlorhexidine 2% in 70% alcohol swabs (3 per site and 1 per culture collection bottle)  Gloves, non-sterile  10 mL pre-filled Normal Saline syringes (1 per site, 2 if implanted port)  Blood culture collection containers (ensure to check expiry date on bottles)  Appropriate blood collection tubes if collecting further blood work from CVL (ensure to check expiry date on tubes)  Blood transfer vacutainer device (1 per lumen)  Sterile dead-end cap if interrupting IV infusion (1 per lumen)  Empty sterile 10 mL syringe (amount of syringes dependent on number of lumens and volume of blood to be collected) - NOTE: the use of vacutainer is not recommend for blood collections due to importance regarding accuracy of blood volume to be drawn - NOTE: larger syringes may be used on cuffed CVCs, short term uncuffed CVCs and Implanted ports however ONLY 10mL syringes may be used on PICC lines for blood collection

If Heparin locking post blood collection (see “Heparin Locking Central Venous Lines” Procedure Document):  10 mL pre-filled syringe with heparin 10units/mL (1 per lumen)  SwabcapTM if appropriate (1 per lumen)

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DOCUMENT TYPE: GUIDELINE

Procedure for Central Venous Line Collection

STEPS RATIONALE 1. REVIEW physician orders for blood cultures and determine if Indications for Anaerobic cultures include: anaerobic cultures are to be collected. Oncology patients will routinely • intraabdominal or pelvic infection, require anaerobic cultures and other patients will have anaerobic necrotizing enterocolitis in neonates cultures only if specifically ordered by the physician. • mouth/neck infection, including septic thrombophlebitis (e.g. Lemierre’s) • necrotizing soft tissue infection • infected bite wounds • immunosuppressed host • prolonged fever of unknown origin with negative aerobic cultures • All children >40 kg 2. PERFORM a Point of Care Risk Assessment (PCRA) of the patient Routine infection control practices prior to and select appropriate PPE. Confirm if the patient is on any additional entering patient environment. precautions and DON appropriate PPE and PERFOM hand hygiene. Please refer to: Routine Practices – Hand Hygiene IC.03.03 Donning (Putting On) Personal Protective Equipment 3. IDENTIFY patient by comparing name on requisition and labels to Failure to correctly identify patients prior to patient ID band or hospital approved photo ID. Please refer to Patient procedures may result in errors and/or identification Policy. recollection.

NOTE: Paper requisitions can be brought into patient room even if on isolation. 4. EXPLAIN the procedure to the patient and family. Evaluates and reinforces understanding of previously taught information and confirms consent for procedure. May help to reduce anxiety/concern about current clinical situation patient is in. 5. CLEAN non-porous work surface with hospital grade surface Routine infection control practices. Reduces disinfectant wipe and let dry for recommended contact time. transmission of microorganisms. 6. PERFORM hand hygiene as per infection control standards. Routine infection control practices prior to CVL care. 7. PREPARE equipment using aseptic no-touch technique at the Routine infection control practices. bedside of the patient. 8. REMOVE the protective cover on the top(s) of the blood culture Decrease risk of blood culture contamination. collection bottle(s) and SCRUB the top of the culture bottle with Chlorhexidine 2% in 70% alcohol swabs for 30-60 seconds using good friction. Allow to dry for 1 minute. 9. CLAMP CVL catheter. If second lumen infusing, CLAMP second Both lumens must remain clamped during lumen. blood sampling to ensure no contamination or dilution of blood samples. However, it may not NOTE: If high risk infusion running in second lumen, it may not be be clinically appropriate for patients appropriate to clamp second lumen or draw blood from this lumen. In dependent on a high risk infusion to clamp these scenarios, please consult with physician prior to clamping second lumen (i.e. inotropes, insulin infusion second lumen. etc.) 10. PAUSE or DELAY infusion on IV pump. If CVL is locked, this step is not required. 11. PERFORM hand hygiene and DON non-sterile gloves. Routine infection control practices. Gloves to protect health care provider. 12. REMOVE IV tubing and attach sterile dead-end cap to open end of IV line to keep covered. If CVL locked, ignore this step. 13. SCRUB the needleless connector (cap) for 30 second with Routine infection control practices. Decreases Chlorhexidine 2% in 70% alcohol swab and allow to dry for one risk of contamination. Chlorhexidine is active minute. Repeat with a second swab and clean up the line from the cap against Gram-positive and Gram-

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DOCUMENT TYPE: GUIDELINE

towards the clamp, including the clamp. Allow to dry for one minute. negative organisms, facultative anaerobes, aerobes, and yeast. Must TM NOTE: If CVL has had a Swabcap on the needleless connector for allow for full dry time to be effective. >5minutes you may remove the SwabcapTM and proceed to the next step without cleaning if the SwabcapTM has not been compromised. 14. ATTACH empty sterile sample syringe to needleless connector using aseptic technique. 15. UNCLAMP catheter and WITHDRAW appropriate amount of blood Opposite lumen must remain clamped during required by pulling back on the plunger of syringe gently. Refer to blood sampling to ensure no contamination or Table 1 or 2 at the beginning of the guideline to determine appropriate dilution of blood samples. amount of blood required for culture bottle(s) based on patient’s weight. Ensuring the appropriate amount of blood volume will result in an accurate blood culture NOTE: “Discard” blood can be used from a CVL for blood culture test. Low volumes may lead to false negative unless there is an indwelling antibiotic therapy (i.e. “antibiotic lock” reports. therapy) in the CVL. In this case, the discard volume should not be used for the blood culture. If this is the case, remove the appropriate If you pull back too quickly, the blood may amount of blood for discard into sample syringe and CLAMP catheter. rush into the syringe too quickly causing lysis REMOVE syringe from needless connector and immediately dispose or hemolysis of the cells. of the discarded blood. The appropriate volume of discard is depending on the patient’s weight and line type: Removes antibiotic solution from catheter to ensure uncontaminated blood specimen is Type of CVL Amount of discard places in blood culture bottle. External cuffed CVC < 10 kg 1.5 mL External cuffed CVC > 10 kg 3 mL Un-cuffed Short Term CVC 1.5 mL Implanted Port 3 mL PICC 2.6 Fr 1 mL

Cuffed/uncuffed PICC > 2.6Fr and 1.5 mL < 10 kg Cuffed/uncuffed PICC > 2.6Fr and 3 mL > 10 kg Hemodialysis/Apheresis 3 mL

16. CLAMP catheter, REMOVE syringe from needless connector and Once in tubes, inverting ensures blood cells IMMEDIATELY TRANSFER blood from sterile sample are all mixed with additives in tubes. syringe to appropriate blood culture collection bottles and/or blood tubes using the blood transfer vacutainer DO NOT SHAKE or will cause cell lysis. device. Inverting or mixing blood in sample syringe will cause hemolysis and dramatically impact accuracy of results. Blood must be REFER to Order of Draw reference tool to ensure immediately transferred to appropriate tube or appropriate transfer order and appropriate number collection bottle with the least amount of of inversions per blood tube. manipulation as possible.

DO NOT invert blood while in sterile sample syringes.

If putting blood into micro-tubes, remove top of micro-tube and gently depress blood filled syringe to add appropriate amount of blood to micro-tube. To ensure tip of syringe is not contaminate

before blood is transferred into blood culture bottle.

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DOCUMENT TYPE: GUIDELINE

Note: If you do not have a buddy RN to assist in this process, to keep end of CVL clean while you are transferring the blood, you may ATTACH the next empty sterile sample syringe to needless connector (if further blood sampling is required) or, if no further bloodwork required, ATTACH sterile NS pre-filled syringe and allow line to rest, clamped, with syringe attached until you have completed transferring all the blood. 17. If further blood sampling required, if you have not done so already, ATTACH un-used sterile sample syringe or vacutainer, UNCLAMP catheter and WITHDRAW required amount of blood until full volume of blood has been collected from lumen and all blood transferred into appropriate collection tubes. Refer to Blood Sampling from CVL policy.

If no further blood sampling required, ATTACH pre-filled normal saline syringe, UNCLAMP catheter and with thumb on the plunger of the syringe, give two-three quick pushes of the normal saline into the Creates turbulent flow to clear catheter of catheter. Then with a continuous fast motion, FLUSH into the blood and help maintain patency of the line. needleless connector and catheter with remaining normal saline Flush must always be done. Do not connect required: back to line and use IV fluids to flush the line.

Type of CVL Minimum NS Flush Required External cuffed CVC< 10 kg 3 mL External cuffed CVC > 10 kg 9 mL Un-cuffed Short TermCVC 3 mL Implanted Port < 10kg 9 mL Implanted Port > 10kg 18 mL (use x2 pre-filled 10 mL syringes) PICC 2.6Fr 1 mL Cuffed/Uncuffed PICC >2.6Fr and 3 mL < 10 kg Cuffed/Uncuffed PICC >2.6Fr and 9 mL > 10 kg Hemodialysis/Apheresis 9 mL

18. RECONNECT infusion set and commence infusion or LOCK line Resumes therapy as ordered. as ordered (ie: Heparin lock). Opposite lumen must remain clamped during NOTE: If second lumen is present, keep lumen #1 clamped or lock blood sampling to ensure no contamination or lumen #1 and then repeat steps 12-18 on lumen #2. Ensure IV therapy dilution of blood samples. is never running into a lumen while drawing blood out of the second lumen with the exception noted in step #8 regarding high risk It may not be clinically appropriate for patients infusions. dependent on a high risk infusion to clamp second lumen for any length of time (ie: inotropes, insulin infusion etc.) consult physician team.

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19. COMPLETE site to source safety check of IV infusion system. Site Decrease risk of infiltration or extravasation. assessment (“TLC”). Ensure fluid running through all CVL lumens. All Ensure line remains patent. connections are secure and clamps are in appropriate position. 20. LABEL blood culture collection bottles and other blood tubes at Safe blood sampling practices. See “Blood patient’s bedside. Label must include MRN, first and last name, date of Sampling from Central Venous Lines” birth, date and time sample drawn and on blood culture bottle must procedure for further details including Group indicate which site (ie: white lumen, medial port, peripheral etc.) and Screen procedure. 21. PLACE specimens into transport bags. 22. REMOVE gloves and PERFORM hand hygiene. If patient is on any Routine infection control practices. additional precautions, please follow proper hand hygiene and PPE DOFFING procedures. Refer to DOFFING (TAKING OFF) PERSONAL PROTECTIVE EQUIPMENT: DROPLET & CONTACT AND AIRBORNE PRECAUTIONS (INCLUDES AEROSOL-GENERATING MEDICAL PROCEDURES) 23. COMPLETE appropriate laboratory requisitions for blood cultures, this includes indicating the site where blood sample was obtained, RN Signing the requisitions confirms you have initials, date and time. Each site of collection must have its own correctly identified the patient. requisition. Ensure patient’s weight is indicated on the blood culture requisition(s). PLACE requisitions into transport bags with the appropriate specimens. 24. ARRANGE for transport to the lab. Blood culture collection bottles may be tubed via the pneumatic tube system.

NOTE: all samples being sent via pneumatic tube system in the Teck ACC building must be put inside appropriate zip and fold bag. If unable to locate zip and fold bag, a porter must be called to deliver specimens.

Equipment for Peripheral Blood Culture Collection with IV Start

 Requisitions and computerized or addressograph labels for patient - note that each “site” requires its own requisition  Chlorhexidine 2% in 70% alcohol swabs x 6  Gloves, non-sterile  Blood culture collection containers  Appropriate blood collection tubes if collecting further blood work  Blood transfer vacutainer device  Empty sterile 10mL syringe (amount of syringes dependent on volume of blood to be collected)  All equipment required for initiating a PIV. See INITIATING A PERIPHERAL INTRAVENOUS (PIV) policy .

Procedure for Peripheral Blood Culture Collection with IV Start

STEPS RATIONALE 1. REVIEW physician orders for blood cultures and determine if Indications for Anaerobic cultures include: anaerobic cultures are to be collected • intraabdominal or pelvic infection, necrotizing enterocolitis in neonates • mouth/neck infection, including septic thrombophlebitis (e.g. Lemierre’s) • necrotizing soft tissue infection • infected bite wounds • immunosuppressed host • prolonged fever of unknown origin with negative aerobic cultures • All children >40 kg

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DOCUMENT TYPE: GUIDELINE

2. PERFORM a Point of Care Risk Assessment (PCRA) of the Routine infection control practices prior to patient and select appropriate PPE. Confirm if the patient is on any entering patient environment. additional precautions and DON appropriate PPE and PERFOM Please refer to: Routine Practices – Hand hand hygiene. Hygiene IC.03.03 Donning (Putting On) Personal Protective Equipment 3. IDENTIFY patient by comparing name on requisition and labels Failure to correctly identify patients prior to to patient ID band or hospital approved photo ID. Please refer to procedures may result in errors Patient identification Policy.

NOTE: Paper requisitions can be brought into patient room even if on isolation. 4. EXPLAIN the procedure to the patient and caregiver. Evaluates and reinforces understanding of previously taught information and confirms consent for procedure. May help to reduce anxiety/concern about current clinical situation patient is in. 5. CLEAN non-porous work surface with hospital grade disinfectant Routine infection control practices. Reduces wipe and let dry for recommended contact time. transmission of microorganisms. 6. PERFORM hand hygiene as per infection control standards. Routine infection control practices. 7. PREPARE equipment using aseptic no-touch technique at the Routine infection control practices. bedside of the patient. 8. REMOVE the protective cover on the blood culture collection Decrease risk of blood culture contamination. bottle and SCRUB the top of the culture bottle with Chlorhexidine 2% in 70% alcohol swabs for 30-60 seconds using good friction. Allow to dry for 1 minute. 9. INITIATE PIV – review INITIATING A PERIPHERAL INTRAVENOUS (PIV) policy and DON clean non sterile gloves. 10. Once PIV insitu, CLAMP PIV extension tubing. REMOVE tip of PIV extension. 11. ATTACH sterile syringe to PIV extension tubing using aseptic technique. 12. UNCLAMP catheter and WITHDRAW appropriate amount of Ensuring the appropriate amount of blood blood required by pulling back on the plunger of syringe gently. volume will result in an accurate blood culture Refer to Table 1 or 2 at the beginning of the guideline to determine test. Low volumes may lead to false negative appropriate amount of blood required for culture bottle(s) based on reports. patient’s weight.

13. CLAMP extension tubing. REMOVE syringe from To ensure tip of syringe is not contaminate needless connector and attach blood transfer before blood is transferred into blood culture vacutainer device. bottle.

To keep end of PIV extension tubing clean, you may ATTACH the next empty sterile sample syringe to needless connector (if further blood sampling is required) or, if no further bloodwork required, ATTACH sterile NS pre-filled syringe and allow line to rest, clamped, with syringe attached.

14. IMMEDIATELY TRANSFER blood from sterile sample syringe Once in tubes, inverting ensures blood cells are to appropriate blood culture collection bottles and/or blood tubes all mixed with additives in tubes. using the blood transfer vacutainer device. DO NOT SHAKE or will cause cell lysis.

Inverting or mixing blood in sample syringe will cause hemolysis and dramatically impact accuracy of results. Blood must be immediately

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DOCUMENT TYPE: GUIDELINE

transferred to appropriate tube or collection bottle with the least amount of manipulation as possible.

GENTLY invert each tube/bottle after blood is added. Please refer to Order of Draw reference tool to ensure appropriate transfer order and appropriate number of inversions per blood tube. DO NOT invert blood while in sterile sample syringes.

If putting blood into micro-tubes, remove top of micro-tube and gently depress blood filled syringe to add appropriate amount of blood to micro-tube. 15. If further blood sampling required, using new sterile sample syringe, UNCLAMP catheter and WITHDRAW required amount of blood and repeat steps 10-14 until full volume of blood has been collected and all blood transferred into appropriate collection tubes.

If no further blood sampling required, using pre-filled normal saline syringe, UNCLAMP extension tubing and with a thumb on the Creates turbulent flow to clear catheter of blood plunger of the syringe, give two-three quick pushes of the normal and help maintain patency of the line. Flush saline into the tubing. Then with a continuous fast motion, FLUSH must always be done. Do not connect back to the rest of the normal saline required into the line. line and use IV fluids to flush the line. 16. ATTACH needless connector to end of PIV extension tubing Ensures patency of PIV. and COMMENCE IV therapy infusion per orders or SALINE LOCK PIV per orders. 17. COMPLETE site to source safety check of IV infusion system. Decrease risk of infiltration or extravasation. Site assessment (“TLC”). If IV therapy infusing, ensure all Ensure line remains patent. connections are secure and clamps are in appropriate position. 18. LABEL blood culture collection bottles and other blood tubes at patient’s bedside. Label must include MRN, first and last name, Safe blood sampling practices. See transfusion date of birth, date and time sample drawn and on blood culture medicine guidelines for appropriate labelling of bottle must indicate which site (e.g. peripheral site) group and screen samples. 19. COMPLETE appropriate laboratory requisitions for blood cultures, this includes indicating the site where blood sample was obtained, RN initials, date and time. Each site of collection must have its own requisition. Ensure patient’s weight is indicated on the blood culture requisition(s). PLACE requisitions into transport bags with the appropriate specimens. 20. REMOVE gloves and PERFORM hand hygiene. If patient is on Routine infection control practices. any additional precautions, please follow proper hand hygiene and Refer to DOFFING (TAKING OFF) PERSONAL PPE DOFFING procedures. PROTECTIVE EQUIPMENT: DROPLET & CONTACT AND AIRBORNE PRECAUTIONS (INCLUDES AEROSOL- GENERATING MEDICAL PROCEDURES) 21. ARRANGE for blood samples to be transported to the lab. Blood culture collection bottles may be tubed via the pneumatic tube system.

NOTE: all samples being sent via pneumatic tube system in the Teck ACC building must be put inside appropriate zip and fold bag.

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DOCUMENT TYPE: GUIDELINE

If unable to locate zip and fold bag, a porter must be called to deliver specimens.

Documentation DOCUMENT on appropriate record(s) – Nurses Notes, PIV initiation flowsheet and/or CVL flowsheet if appropriate

 Procedure and time  Any difficulties with blood return from the CVL  Patient’s response to procedure if unusual

References 1. Campigotto A, Richardson SE, et al. Low Utility of Pediatric Isolator Blood Culture System for Detection of Fungemia in Children: a 10-Year Review. J Clin Microbiol. 2016 Sep;54(9):2284-7. 2. Gaur AH, et al. Optimizing blood culture practices in pediatric immunocompromised patients: evaluation of media types and blood culture volume. Ped Infect. Dis. J. 2003. 3. Gonsalves WI, Cornish N, Moore M, Chen A, Varman M. Effects of volume and site of blood draw on blood culture results. J Clin Microbiol. 2009 Nov;47(11):3482-5. 4. Isaacman DJ, Karasic RB, Reynolds EA, Kost SI. Effect of number of blood cultures and volume of blood on detection of bacteremia in children. J Pediatr. 1996 Feb;128(2):190-5 5. JP Buttery. Blood cultures in newborns and children: optimising an everyday test. Arch Dis Child Fetal Neonatal Ed, 2002, 87: F25-F28. 6. OʼMalley, Christine & Sriram, Sudhir & White, Melissa & Polinski, Carol & Seng, Carolyn & Schreiber, Michael. (2018). Feasibility and Outcomes Associated With the Use of 2.6-Fr Double-Lumen PICCs in Neonates. Advances in Neonatal Care. 19. 1. 10.1097/ANC.0000000000000570. 7. TG Connell, M Rele, D Cowley, JP Buttery and N Curtis. How Reliable is a Negative Blood Culture Result? Volume of Blood Submitted for Culture in Routine Practice in a Children’s Hospital. Pediatrics, 2007, 119; 891.

Definitions

Patient: any person receiving services from C&W.

Consent: for the purpose of this guideline, consent is a signed acknowledgment from a patient to permit a specified action in relation to that patient's personal or Sensitive Information. Consent must be retained in either physical form (Signature; paper based record) or electronic form (“I agree”; “yes”; ticked check-box) as part of an electronic health record.

Staff: all officers, directors, employees, contractors, physicians, health care professionals, students and volunteers employed or contracted by C&W.

Health Care Provider: C&W Staff who are providing direct health-related care to a patient.

Aseptic no-touch technique (ANTT): a standardized technique that is used during clinical procedures to identify and prevent microbial contamination of aseptic key parts and key sites by ensuring that they are not touched either directly or indirectly. A ‘key part’ is the part of the equipment that must remain sterile and must only contact other key parts or key sites. Or it is the area on the patient such as a wound, or IV insertion site that must be protected from microorganisms. Aseptic key parts can only contact other aseptic key parts/sites. If it is necessary to touch key parts/sites, sterile gloves are to be worn to ensure asepsis is maintained.

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DOCUMENT TYPE: GUIDELINE

Developed By BCCH Oncology/Hematology/BMT Program – Clinical Nurse Educator

Version History

DATE DOCUMENT NUMBER and TITLE ACTION TAKEN 06-Jun-2018 CC.03.48 Pediatric Blood Culture Guide Approved at: BC Children’s Best Practice Committee 06-Feb-2019 C-05-07-60031 Pediatric Blood Culture Guide Approved at: BC Children’s Best Practice Committee 01-Jun-2021 “ Approved at: C&W Best Practice Committee

Disclaimer

This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.

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