Impact, barriers, and facilitators of blood culture diversion devices to reduce blood culture contamination and improve patient safety: a scoping review

Blood culture contamination (BCC) is a frequent and costly challenge in clinical diagnostics. BCC leads to extended hospital stays, unnecessary antimicrobial therapy, diagnostic delays, and increased healthcare costs, sometimes exceeding $100,000 per case depending on the scope of analysis. It also contributes to environmental waste and reputational harm. Blood culture diversion (BCD), particularly via blood culture diversion devices (BCDDs), has emerged as a promising strategy to reduce BCC. BCDDs divert initial blood flow, likely contaminated with skin flora, thereby improving diagnostic accuracy. This scoping review analysed 23 studies, including randomised controlled trials and observational designs. BCD was an effective method to reduce the rate of BCC. BCDDs consistently outperformed open diversion methods in reducing BCC rates. However, findings on their impact on antimicrobial usage, hospital length of stay, and cost-effectiveness varied. Some studies reported significant cost savings and reduced vancomycin use, while others showed minimal change. Barriers to BCDD adoption include financial constraints, inconsistent definitions of BCC, and variable staff compliance. Enablers include positive user feedback, targeted training, and integration into national surveillance frameworks. Evidence gaps remain in comparative effectiveness, sustainability metrics, and behavioural factors influencing implementation. The review recommends broader adoption of BCDDs, particularly in high-risk settings, emphasising the need for local data to identify where implementation will be most effective. It also calls for standardised definitions, improved surveillance, and further research into broader clinical, economic, and environmental outcomes.